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PubMed2002

Effects of left ventricular systolic dysfunction on left atrial appendage and left atrial functions in patients with chronic nonvalvular atrial fibrillation.

OBJECTIVE: It has been claimed that left ventricular (LV) systolic dysfunction impairs left atrial (LA) and left atrial appendage (LAA) functions. In this study, we compared the LA and LAA function parameters in patients with chronic nonvalvular atrial fibrillation (AF) with and without LV systolic dysfunction. METHODS AND RESULTS: The study population consisted of 28 patients with chronic nonvalvularAF. Group I consisted of 12 patients with LV systolic dysfunction (mean age: 61 +/- 14 years; LV ejection fraction: 44 +/- 6%), group II of 16 patients with normal LV systolic function (mean age: 52 +/- 15 years; LV ejection fraction: 65 +/- 3%). LV ejection fraction (EF) was measured by echocardiography utilizing bi-plane area length method. The following LA and LAA transoesophageal echocardiography parameters were obtained: I) LA diameter, 2) LAA ejection velocity, 3) LAA filling velocity, 4) LAA ejection fraction, 5) pulmonary venous (PV) systolic velocity, 6) PV diastolic velocity, 7) PV systolic velocity/diastolic velocity ratio. The left atrium diameter was significantly larger in group I than in group 11 (4.7 +/- 0.7 cm vs. 3.8 +/- 0.6 cm, p < 0.05). The LAA ejection velocity and LAA ejection fraction were significantly lower in group I than in group 11 (22.6 +/- 15.5 cm/s vs 37.5 +/- 11.3 cm/s and 26.9 +/- 20.8% vs. 41.3 +/- 10.9%, p < 0.05 for both comparisons). The PV systolic velocity and PV systolic velocity/diastolic velocity ratio were significantly smaller in group I than in group II (26.2 +/- 14.8 cm/s vs. 51.5 +/- 22 cm/s and 0.7 +/- 0.6 vs. 1.2 +/- 0.5, p < 0.05 for both comparisons). Although decreased LAA filling and PV diastolic velocities were determined in group I, no significant difference existed between groups I and II. Thrombus and/or spontaneous echo contrast (SEC) in the LA and/or LAA were more frequent in group I (75% vs. 18%, p < 0.05). CONCLUSION: These results indicate that LV systolic dysfunction impairs various LA and LA function parameters and is associated with an increased frequency of SEC and/or LA thrombus in patients with chronic nonvalvularAF.

Adult↗
PubMed2002

Left atrial function: bridge to central and hormonal determinants of exercise capacity in patients with chronic heart failure.

UNLABELLED: The stroke volume response to exercise is a critical determinant in meeting peripheral metabolic demands in patients with chronic hear failure. The Left atrium, by its position, is important in coupling right and left ventricles, to left preload reserve and to modulate sympathetic activity. We performed this study to investigate the relationship between exercise capacity and diastolic and systolic left atrium function in patients with chronic heart failure. METHODS: We considered 128 consecutive patients with severe chronic heart failure (EF < 35%) due to ischemic or idiopathic dilated cardiomyopathy. Cardiac output, right atrial pressure, pulmonary artery pressures and mean pulmonary wedge pressure (A, X, V, Y wedge pressures) were determined during right cardiac catheterization. By Echocardiography evaluation, we measured atrial pressures and volume during early and late left atrial systolic filling and we calculated left atrial chamber stiffness by this equation P = A*eKV1. (P = left atrial pressure; A = elastic constant (mmHg*ml); e = the base of the natural logarithm; V1 = left atrial volume (ml); K = left atrial chamber stiffness constant (ml-1) = ln (V/X)/(maximal--minimal left atrial volumes)). All patients performed cardiopulmonary exercise test with modified Noughton protocol. Plasma norepinephrine and Atrial natriuretic factor levels were determined. RESULTS: Maximal and minimal left atrial volumes were inversely related to oxygen consumption (r = -.44, p < .001; r = -.61, p < .001). At rest, no differences were found in plasma norepinephrine concentrations (309 +/- 152 pg/ml vs 309 +/- 394 pg/ml; p = ns) and systemic vascular resistance (1706 +/- 435 vs 1771 +/- 524 dynes/cm sec-5; p = ns) in patients with large or normal left atrial volumes. During exercise the chronotropic response increased less in patients with large atrial volumes (56 +/- 13 vs 45 +/- 14; p = .001). The left atrial chamber stiffness constant was inversely related to peak oxygen consumption and exercise time. Patients with different chamber stiffness showed statistical difference in peak VO2 (16 +/- 4 vs 11 +/- 3 ml/kg/min; p = .0001). Left atrial ejection fraction was directly related to peak oxygen consumption (r = 0.55), but the most strongly correlation was with atrial filling fraction (r = .67). CONCLUSIONS: This study demonstrates a strong relationship between left atrial function and exercise capacity in patients with chronic heart failure.

Chronic Disease↗
PubMed2002

Left atrial function preserves pulmonary circulatory pressure during pacing-tachycardia and contributes to exercise capacity in patients with idiopathic dilated cardiomyopathy in sinus rhythm, whose exercise is limited by dyspnea.

The aim of this study was to determine whether left atrial (LA) function contributes to pulmonary circulatory pressure during pacing-tachycardia and exercise capacity in patients with idiopathic dilated cardiomyopathy (DCM). Thirty-two patients with DCM and in sinus rhythm had limited exercise capacity because of dyspnea. The correlation between peak oxygen consumption (VO2) and the variables of cardiac function by cardiac catheterization and 2-dimensional, Doppler echocardiography, and plasma neurohumoral factor levels was tested, as was the correlation between non-invasive LA functional parameters and pulmonary circulatory pressure during pacing-tachycardia. A significant correlation was observed between VO2 and LA dimension (r = -0.45, p < 0.01), the peak velocities of LA appendage empty flow during atrial systole (r = 0.63, p < 0.0001) and the pulmonary venous forward flow in early ventricular systole (PVS1; r = 0.74, p < 0.0001), as well as plasma brain natriuretic peptide (BNP) concentrations. The predictable equation to VO2 with the multiple regression analysis was: VO2 = -0.01 BNP+0.21 PVS1+15.4 (r = 0.81, p < 0.0001). Furthermore, LA functional variables derived from pulmonary venous flow, especially PVS1, but not plasma BNP concentration, were useful for predicting the degree of the increase in pulmonary circulatory pressure during pacing-tachycardia. Therefore, it is suggested that LA function contributes to exercise capacity through its influence on pulmonary hemodynamic reserve in patients with DCM with sinus rhythm whose exercise is limited by dyspnea.

Adult↗
PubMed1999

Changes in left ventricular filling and left atrial function six months after nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy.

OBJECTIVES: The purpose of this study was to evaluate changes in left ventricular (LV) filling, left atrial (LA) volumes and function six months after nonsurgical septal reduction therapy (NSRT) for hypertrophic obstructive cardiomyopathy (HOCM). BACKGROUND: Patients with HOCM frequently have enlarged left atria, which predisposes them to atrial fibrillation. Nonsurgical septal reduction therapy results in significant reduction in left ventricular outflow tract (LVOT) obstruction and symptomatic improvement. However, its effect on LV passive filling volume, LA volumes and function is not yet known. METHODS: Thirty patients with HOCM underwent treadmill exercise testing as well as 2-dimensional and Doppler echocardiography before and six months after NSRT. Data included clinical status, exercise duration, LVOT gradient, mitral regurgitant (MR) volume, LV pre-A pressure and LA volumes. Left atrial ejection force and kinetic energy (KE) were computed noninvasively and were compared with 12 age-matched, normal subjects. RESULTS: New York Heart Association (NYHA) class was lower and exercise duration was longer (p < 0.05) six months after NSRT. The LVOT gradient, MR volume and LV pre-A pressure were all significantly reduced. HOCM patients had larger atria, which had a higher ejection force and KE, compared with normal subjects (p < 0.01). After NSRT, LV passive filling volume increased (p < 0.01), whereas LA volumes, ejection force and KE decreased (p < 0.01). Reduction in LA maximal volume was positively related to changes in LV pre-A pressure (r = 0.8, p < 0.05) and MR volume (0.4, p < 0.05). Changes in LA ejection force were positively related to changes in LA pre-A volume (r = 0.7, p < 0.01) and KE (r = 0.81, p < 0.01). The increase in exercise duration paralleled the increase in LV passive filling volume (r = 0.85, p < 0.05). CONCLUSIONS: Nonsurgical septal reduction therapy results in an increase in LV passive filling volume and a reduction in LA size, ejection force and KE.

Adult↗
PubMed1999

Echocardiographic determination of left atrial function and its application for assessment of mitral flow velocity pattern.

We determined left atrial (LA) volume changes to evaluate LA function, and to correlate the Doppler-determined mitral flow velocity (MFV) pattern. Twenty-four patients with ischemic heart disease who showed 'normal' MFV pattern by pulsed Doppler echocardiography were studied. The patients were divided into 14 patients with left ventricular end diastolic pressure < 18 mmHg (true normals) and 10 patients with > or = 18 mmHg (pseudo normals). The changes in LA volume were determined by echocardiography from apical two- and four-chamber views with modified Simpson's method. The volume measurements were done at the time of mitral valve opening (Vmax), at onset of atrial systole (Va) and at mitral valve closure (Vmin). Then the passive LA emptying volume was calculated by subtracting Va from Vmax, and the active LA emptying volume by subtracting Vmin from Va. The LA ejection fraction was calculated by the formula: [(Va-Vmin)Va] x 100. There was no significant difference in LA ejection fraction in pseudo normal (39+/-6%) and in true normal (41+/-13%) patients. Although the passive LA emptying volume was 16+/-4 ml/beat in true normal and was 11+/-3 ml/beat in pseudo normal (NS), the active LA emptying volume was significantly greater in pseudo normals (22+/-4 m/beat) than in true normals (12+/-2 ml/beat, P<0.001). Thus, the ratio of passive and active LA emptying volume was markedly greater in true normals (1.28+/-0.35) than in pseudo normals (0.52+/-0.19, P<0.001), facilitating the differentiation of these two groups. These results indicate that two-dimensional echocardiographic measurement of LA volume can be valuable in assessing the LA function, providing an alternative method for differentiating pseudo normal from true normal MFV pattern in clinical settings, although several technological shortcomings should be resolved.

Adult↗
PubMed1997

Relationship between atrial function, left ventricular isovolumic relation time, and early filling in dual chamber-paced patients.

This investigation was performed to study atrial systolic function is response to modification of atrioventricular delay in a sample of 36 patients with a DDD pacemaker implanted for complete atrioventricular block. The relation between atrial systolic performance and diastolic-related parameters was also evaluated. Isovolumic relaxation time, early diastolic peak velocity, late (atrial) diastolic peak velocity, atrial filing fraction, and atrial ejection force were recorded at a pacing rate of 70 impulses/min and at atrioventricular delay of 200, 150, and 100 msec. Our data showed that the progressive shortening of atrioventricular delay induced a gradual increase in early peak velocity (median value 46 to 53 to 61.5 cm/sec, respectively, at 200, 150, and 100 msec intervals) and a gradual decrease in isovolumic relaxation time (median 92.6 to 81.5 to 69.7 msec at 200, 150, and 100 msec, respectively), atrial peak velocity (59 to 52 to 44.5 cm/sec at 200, 150, and 100 msec, respectively), atrial filling fraction (50.5% to 40% to 23.5% at 200, 150, and 100 msec, respectively), and atrial ejection force (17.2 to 14.7 to 8.5 kilodynes at 200, 150, and 100 msec, respectively). For every atrioventricular delay value detected, we found a significant correlation between isovolumic relaxation time and early peak velocity with atrial filling fraction and atrial ejection force. In addition, atrial ejection force was related directly to atrial filling fraction at studied atrioventricular delays. The two indexes of atrial systolic performance showed a parallel decrease by shortening the atrioventricular delay, and they can quantify atrial systolic performance equally in sequentially paced patients. Furthermore, our results are in accordance with the hypothesis that the interaction between the effectiveness of active left atrial emptying and isovolumetric relaxation time may play an important role in maintaining an ideal ventricular filling despite changes in atrial systolic function.

Aged↗
PubMed2006

Effect of beta-blocker therapy on left atrial function in patients with heart failure: comparison of metoprolol succinate with carvedilol.

OBJECTIVE: We aimed to compare the effects of carvedilol and metoprolol succinate on left atrial (LA) function in patients with chronic heart failure. METHODS: Thirty three patients (6 females, 27 males) who had not received beta blocker treatment previously and whose left ventricular ejection fraction was below 40% were included in this study. LA volumes were measured echocardiographically just before the time of mitral valve opening (V (max)), onset of atrial systole (p-wave at the electrocardiography = V (p)) and mitral valve closure (V (min)) according to the biplane area length method at baseline and in the 3rd month after the administration of beta blockers. NT-proBNP level was measured at the beginning and in the third month of beta blocker treatment. The first group was given carvedilol 6.25 mg/day, the second group was given 12.5 mg/day metoprolol succinate and it was increased to the tolerable maximal dose. RESULTS: LA diameter and LA V (max), V (p), V (min) decreased significantly both in carvedilol group and metoprolol group after beta blocker theraphy (P < 0.01, : P < 0.01, : P < 0.05, : P < 0.05: for metoprolol, P < 0.001, P < 0.01, P < 0.01, P < 0.01 for carvedilol). But it was increased in conduit volume (P < 0.05 for two groups). LA-passive emptying fraction, LA-active emptying fraction and reservoir fraction were no significant differences both in carvedilol group and metoprolol group after beta blocker theraphy. NT-proBNP levels were found to decrease significantly in both groups after beta blocker treatment (P < 0.001).: CONCLUSION: Our findings indicate that beta blocker treatment leads to a decrease in LA diameters and volumes, and metoprolol succinate and carvedilol had similar effects on this decrease.

Adrenergic beta-Antagonists↗
PubMed1994

Effect of age on left atrial function in patients with coronary artery disease.

Both coronary artery disease and aging produce a similar pattern of left ventricular diastolic dysfunction with increased left atrial (LA) activity. We studied the Doppler left ventricular filling pattern in 75 patients (age 40-91 years) with coronary artery disease. A linear correlation with age was found for isovolumic relaxation time, peak atrial flow velocity, and atrial filling fraction; an independent effect of age and LA size on these parameters could be demonstrated. As an overall correlation was found between LA diameter and atrial function indexes, we compared such parameters among four subgroups with increasing LA size; the LA function indexes were increased with minor degrees of LA dilation and decreased with further LA expansion. As LA dilation was found only in older patients, it can be supposed that the combined effects of aging and disease on LA wall stress accounted for LA dilation and dysfunction in these subjects.

Aged↗
PubMed2005

Left atrial function, cytokines and soluble apoptotic markers in mitral stenosis: effects of valvular replacement.

BACKGROUND: Patients with mitral stenosis (MS) and heart failure (HF) are characterized by changes in the left atrial (LA) function and activation of the apoptotic process. The purpose of the present study was the evaluation of the effect of mitral valve replacement on the LA function, on inflammatory process and apoptotic markers in patients with MS and HF. METHODS: We studied 30 patients with MS and HF (15 in NYHA III-IV and 15 in NYHA IV) in sinus rhythm (mean age 56.2 +/- 4.6 years), and 20 age and gender matched healthy volunteers. Blood samples were obtained before and 6 months after surgical mitral valve replacement, and plasma levels of soluble Fas/APO-1 receptor (sFas), tumor necrosis factor-alpha (TNF-a) and interleukin-6 (IL-6) were measured. Echocardiographically, LA volumes were measured at mitral valve opening (Vmax), at the onset of left atrial systole (P wave of the electrocardiogram, Vp) and at the mitral valve closure (Vmin). LA contractile function was assessed by the LA active emptying fraction (ACTEF). RESULTS: After mitral valve replacement, TNF-a, IL-6 and sFas levels, as well as the Vmax LA volume, were significantly reduced (p < 0.05). ACTEF showed a significant postoperative decrease (0.29 +/- 0.09 vs. 0.23 +/- 0.06, p < 0.01) and it was significantly correlated with sFas (r = -0.88, p = 0.001), TNF-a (r = -0.81, p = 0.001) and IL-6 (r = -0.74, p = 0.001) levels. CONCLUSION: The present findings indicate that mitral valve replacement in patients with mitral valve stenosis, reduces the size of the left atrium, improves left atrial contractile function and depresses inflammatory and apoptotic process.

Adult↗
PubMed1997

Left atrial function and atrial natriuretic factor/cyclic guanosine monophosphate changes in DDD and VVI pacing modes.

Left atrial systolic function and the plasma of atrial natriuretic factor (ANF) and cyclic guanosine monophosphate (cGMP) were investigated as possible markers for the development of pacemaker syndrome during VVI pacing. Patients who developed pacemaker syndrome during VVI pacing had a significant decrease in left atrial emptying fraction and a substantial increase in ANF and cGMP plasma levels.

Aged↗
PubMed1998

Assessment of left atrial appendage function after cardioversion of atrial fibrillation: relation to left atrial mechanical function.

Although several flow patterns in the left atrial appendage have been described, mechanical determinants of its function have not been elucidated in human beings. We attempted to investigate changes in left atrial appendage function after cardioversion of atrial fibrillation and examine the potential relation between appendage function and left atrial mechanical function. Twenty patients without mitral valvular disease underwent transesophageal and transthoracic echocardiography at 24 hours and 1 week after cardioversion of atrial fibrillation. Left atrial appendage function was assessed by the pulsed Doppler measurements of left atrial appendage emptying and filling velocities corresponding to early and late ventricular diastole, respectively. Left atrial mechanical function was evaluated by the transmitral A-wave velocity, percent atrial contribution of the total left ventricular filling (percent atrial filling), and the pulmonary venous A-wave velocity. Left ventricular function was also estimated with conventional M-mode echocardiography. The late appendage emptying and filling velocities markedly increased during 1 week after cardioversion (p < 0.0001, respectively). This finding was associated with an increase in left atrial mechanical function. Changes in the late emptying and filling velocities significantly correlated with changes in the transmitral A-wave velocity (r = 0.59, p < 0.01), percent atrial filling (r = 0.61, p < 0.005), and the pulmonary venous A-wave velocity (r = 0.56, p < 0.05). In contrast, little change was observed in the early emptying and filling velocities. There was no relation between the indexes of left ventricular function and those of appendage function. In conclusion, unless there was an alteration of the loading conditions, left atrial appendage function improved over several days after cardioversion, and its function was related to left atrial mechanical function.

Adult↗
PubMed2003

[Pulmonary wedge pressure and heart frequency measurements during standardized treadmill exercise for extension of left atrial function diagnosis in warmblood horses].

In 12 healthy warmblood horses (six trained and six untrained) the pulmonary wedge pressure and heart frequency was measured at rest and during a standardised exercise test on a treadmill. The mean pulmonary wedge pressure at rest was 14.53 +/- 2.36 mmHg. There was no significant difference in pulmonary wedge pressure either at rest or during exercise between trained and untrained horses. During walking (1.8 m/s) the mean pulmonary wedge pressure was 19.62 +/- 4.03 mmHg, during trotting (4 und 5 m/s) it was between 22.38 +/- 3.92 mmHg and 25.28 +/- 3.7 mmHg. During canter (6 m/s) and gallop (8 m/s) the mean pulmonary wedge pressure increased to a level of 25.54 +/- 4.3 mmHg and 31.86 +/- 4.29 mmHg. There was a significant increase in pulmonary wedge pressure with each incremental step of the standardised treadmill test. Concerning mean heart frequency a highly significant increase could be observed at the beginning and at the end (treadmill speed of 7 and 8 m/s) of the standardised exercise test. At higher intensity of the exercise test (7 m/s and 8 m/s) untrained horses showed a significantly increased heart rate compared to trained horses. Neither at rest nor during the different exercise levels a significant correlation factor greater 0.5 between heart frequency and pulmonary wedge pressure could be observed. The increase of heart frequency and pulmonary wedge pressure during exercise showed no correlation. Between left atrial size and pulmonary wedge pressure a statistical weak correlation could be observed up to a treadmill velocity of 6 and 7 m/s.

Animals↗
PubMed1981

Left atrial function in acute mitral regurgitation. Factors which modify the regurgitant volume.

Dynamic geometry of the left atrium was studied in open-chest dogs instrumented with ultrasonic dimension gauges for the measurement of the transverse diameter together with left ventricular dimensions and left atrial and ventricular pressures. Three definite phasic changes of the left atrial diameter were observed during the cardiac cycle at the control state; shortening of left atrial diameter with atrial contraction, continuous chamber expansion during ventricular ejection, and either a reduction in the diameter or a plateau during mitral valve opening to onset of the next atrial contraction. Acute onset of mitral regurgitation initially induces a remarkable augmentation of atrial shortening with chamber dilation as a result of an optimal use of the Frank-Starling mechanism of the atrial muscle. When mitral regurgitation is progressively increased, the extent of the atrial shortening and expansion is diminished despite the geometrical advantage of a further increase in atrial diameter, indicating that this extreme dilation no longer provokes the Frank-Starling response and the atrial myocardium is made to operate on a descending limb of function. The amount of regurgitation is highly dependent on the geometry of the mitral orifice and a decrease in regurgitation with vasodilator therapy or with positive inotropic agents may be largely related to a decrease in the size of the left heart cavity, which brings closer together components of the mitral apparatus and increases its competence.

Animals↗
PubMed1983

Effect of the ouabain-quinidine interaction on left ventricular and left atrial function in conscious dogs.

The effect of the ouabain-quinidine interaction was examined in 10 conscious dogs. Left ventricular (LV) pressure, LV dP/dt, LV diameter and left atrial (LA) diameter were measured with high-fidelity micromanometers and sonomicrometer crystals. Ouabain, 0.025 mg/kg, significantly (p less than 0.05) increased LV dP/dt, LV and LA fractional shortening and LV and LA velocity of circumferential fiber shortening (Vcf). In a separate experiment, quinidine was administered as a bolus dose, 3.85 mg/kg, followed by an infusion, 0.28 mg/kg/min. This resulted in steady-state quinidine concentrations that produced no change in wall motion or hemodynamics. When ouabain was given 1 hour into the quinidine infusion, only LV dP/dt increased significantly (p less than 0.05). Ouabain alone increased LV dP/dt 26.4 +/- 3.5%, whereas ouabain during the quinidine infusion increased it by 9.5 +/- 2.3%. Similar differences were seen in the responses to ouabain in the absence and presence of quinidine: LV Vcf, 22.4 +/- 4.9% vs 6.0 +/- 2.1%, LV fractional shortening, 23.1 +/- 4.6% vs 5.8 +/- 2.1%, LA Vcf, 22.7 +/- 5.9 vs 4.6 +/- 2.0% and LA fractional shortening, 21.8 +/- 7% vs 7.8 +/- 3.3%. Thus, in the presence of quinidine the increase in intropy usually seen with ouabain was markedly attenuated. These data suggest that the quinidine-induced increase in digoxin serum concentrations is accompanied by a decrease in the contractile response of the heart to digoxin.

Animals↗
PubMed2005

Usefulness of Doppler assessment of pulmonary vein and left atrial appendage flow following pulmonary vein isolation of chronic atrial fibrillation in predicting recovery of left atrial function.

Atrial fibrillation (AF) is a widespread condition that causes significant morbidity and mortality. Recently, pulmonary venous (PV) isolation using radiofrequency ablation has been used successfully to exclude the pulmonary venous ostia, resulting in correction of AF. Further, miniaturized high-frequency ultrasound phased-array transducers currently provide Doppler and 2-dimensional imaging during the ablation procedure. We examined atrial function and its determinants using intracardiac echocardiography before and after PV isolation in 45 patients who had chronic AF (56 +/- 11 years old). PV, left atrial (LA) appendage, and mitral and tricuspid flows were recorded. Recovery of booster pump function (defined by the presence of mitral inflow A wave, LA appendage a-wave, and PV A-reversal wave velocities >10 cm/s) was observed in 39 of 45 patients (86.6%). PV flow systolic wave before and after ablation correlated with the degree of LA booster pump function after PV isolation. An early systolic PV flow peak velocity >57.47 cm/s predicted "good" LA booster pump function recovery with 96% specificity. Diastolic LA appendage emptying in AF correlated (p <0.001) and predicted good LA booster pump function with 92% specificity for velocities >46.4 cm/s. Thus, monitoring LA function during PV isolation for chronic AF is feasible. Most patients recovered LA booster pump function immediately after PV isolation, and the degree of recovery correlated with LA reservoir function. Preserved reservoir function during AF is predictive of satisfactory recovery of booster pump function after PV isolation.

Aged↗
PubMedDate not supplied

Relationship of left atrial appendage function to left ventricular function.

BACKGROUND: The study was conducted to evaluate the relationship of left atrial appendage function to left ventricular function and to analyze, if left ventricular dysfunction predisposed to left atrial appendage thrombus formation even in the presence of sinus rhythm. METHODS AND RESULTS: The study was conducted in 78 patients with a mean age of 53+/-8.5 years, all of whom were in sinus rhythm. Transesophageal echocardiography was performed to record the left atrial appendage emptying and filling velocity and to look for the presence of spontaneous echo contrast and thrombus. Patients with severe left ventricular dysfunction (Group I--left ventricular ejection fraction < 35%) and patients with moderate left ventricular dysfunction (Group II--left ventricular ejection fraction 35-45%) had lower left atrial appendage emptying velocity (33.6+/-16 and 39.7+/-19.5 cm/s, respectively) and filling velocity (41+/-14.7 and 41+/-17 cm/s, respectively) when compared to patients with preserved systolic function (Group II--left ventricular ejection fraction >45%), who had emptying and filling velocity of 55+/-16 and 56+/-15 cm/s, respectively (p <0.05). Twelve out of 32 (38%) patients with severe left ventricular dysfunction (Group I) and 7 out of 25 (28%) patients with moderate left ventricular dysfunction (Group II) had presence of left atrial appendage thrombus as compared to none of the patients with preserved left ventricular ejection fraction (Group III) (p <0.001). CONCLUSIONS: Patients with left ventricular dysfunction also had left atrial appendage dysfunction as evidenced by lower emptying and filling velocities and had increased incidence of thrombus formation.

Atrial Appendage↗
PubMed1996

Assessment of right and left atrial function in patients with transplanted hearts with the use of magnetic resonance imaging.

BACKGROUND: The purpose of this study was to determine the volumes and cyclic volume changes of the cardiac atria after heart transplantation in physically healthy recipients. METHODS: Ten heart transplant recipients (New York Heart Association grade I) entered the protocol. All operations had been made with classic biatrial anastomoses. Eight healthy volunteers were studied as controls. To measure the volumes of both atria and left ventricular cavity, we used a gradient-echo cine sequence. The 10 mm slices covered both atria over the total cardiac cycle. Images were planimetered, and simultaneous volumes were totalled to give the cavity volume at each time phase. RESULTS: The heart rate of the heart transplant recipients was faster than in controls, which resulted in higher cardiac output. The atrial minimum volumes were significantly larger, and fractional emptying was smaller in transplanted hearts when compared with controls. Reservoir and stroke volumes were smaller and conduit volumes were larger in transplanted hearts than in controls. The atrial filling and emptying rates were lower in heart transplant recipients than in controls. CONCLUSIONS: The classic surgical technique used in heart transplantation results in large atria with decreased volume changes and filling rates even in physically healthy transplant recipients. Magnetic resonance imaging is a reliable tool in assessment of atrial volumes and cyclic function after heart transplantation.

Adult↗