The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial
ischemia cascade where LV diastolic dysfunction often precedes LV systolic
dysfunction, the LA which fashions as an early marker of diastolic anomaly, could
equally reflect a declining LV function and/or be a good predictor of potential
sequelae. We assessed this association of LA function with reduced LV systolic
function among hospitalized patients. Among patients with reduced LV ejection
fraction, LA passive ejection fraction was lower (0.172 ± 0.12 vs. 0.232 ± 0.14,
p = 0.013) whereas LA kinetic energy was higher (6.48 ± 6.3 vs. 4.57 ± 3.5, p =
0.005). Echocardiographic assessment of LA function, therefore, appears
correlated with LVEF and could be important when risk stratifying hospitalized
patients.
References
[1]
Blume, G.G., Mcleod, C.J., Barnes, M.E., Seward, J.B., Pellikka, P.A., Bastiansen, P.M. and Tsang, T.S. (2011) Left Atrial Function: Physiology, Assessment and Clinical Implications. European Journal of Echocardiography, 12, 421-430. https://doi.org/10.1093/ejechocard/jeq175
[2]
Abhayaratna, W.P., Seward, J.B., Appleton, C.P., et al. (2006) Left Atrial Size: Physiologic Determinants and Clinical Applications. Journal of the American College of Cardiology, 47, 2357-2363. https://doi.org/10.1016/j.jacc.2006.02.048
[3]
Kizer, J.R., Bella, J.N., Palmieri, V., et al. (2006) Left Atrial Diameter as an Independent Predictor of First Clinical Cardiovascular Events in Middle-Aged and Elderly Adults: The Strong Heart Study (SHS). American Heart Journal, 151, 412-418. https://doi.org/10.1016/j.ahj.2005.04.031
[4]
Stefanadis, C., Dernellis, J. and Toutouzas, P. (2001) A Clinical Appraisal of Left Atrial Function. European Heart Journal, 22, 22-36. https://doi.org/10.1053/euhj.1999.2581
[5]
Appleton, C.P. and Kovacs, S.J. (2009) The Role of Left Atrial Function in Diastolic Heart Failure. Circulation: Cardiovascular Imaging, 2, 6-9. https://doi.org/10.1161/CIRCIMAGING.108.845503
[6]
Barbier, P., Solomon, S.B., Schiller, N.B. and Glantz, S.A. (1999) Left Atrial Relaxation and Left Ventricular Systolic Function Determine Left Atrial Reservoir Function. Circulation, 100, 427-436. https://doi.org/10.1161/01.CIR.100.4.427
[7]
Fujii, K., Ozaki, M., Yamagishi, T., et al. (1994) Effect of Left Ventricular Contractile Performance on Passive Left Atrial Filling: Clinical Study Using Radionuclide Angiography. Clinical Cardiology, 17, 258-262. https://doi.org/10.1002/clc.4960170508
[8]
Grant, C., Bunnell, I.L. and Greene, D.G. (1964) The Reservoir Function of the Left Atrium during Ventricular Systole: An Angiocardiographic Study of Atrial Stroke Volume and Work. The American Journal of Medicine, 37, 36-43. https://doi.org/10.1016/0002-9343(64)90210-4
[9]
Sigwart, U, Grbic, M., Goy, J.J. and Kappenberger, L. (1990) Left Atrial Function in Acute Transient Left Ventricular Ischemia Produced during Percutaneous Transluminal Coronary Angioplasty of the Left Anterior Descending Coronary Artery. The American Journal of Cardiology, 65, 282-286. https://doi.org/10.1016/0002-9149(90)90288-C
[10]
Stewart, J.T., Grbic, M. and Sigwart, U. (1992) Left Atrial and Left Ventricular Diastolic Function during Acute Myocardial Ischaemia. British Heart Journal, 68, 377-381. https://doi.org/10.1136/hrt.68.10.377
[11]
Matsuda, Y., Toma, Y., Ogawa, H., et al. (1983) Importance of Left Atrial Function in Patients with Myocardial Infarction. Circulation, 67, 566-571. https://doi.org/10.1161/01.CIR.67.3.566
[12]
Lang, R.M., Bierig, M., Devereux, R.B., et al. (2005) Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology. Journal of the American Society of Echocardiography, 18, 1440-1463. https://doi.org/10.1016/j.echo.2005.10.005
[13]
Triposkiadis, F., Harbas, C., Sitafidis, G., Skoularigis, J., Demopoulos, V. and Kelepeshis, G. (2008) Echocardiographic Assessment of Left Atrial Ejection Force and Kinetic Energy in Chronic Heart Failure. The International Journal of Cardiovascular Imaging, 24, 15-22. https://doi.org/10.1007/s10554-007-9219-7
[14]
Stefanadis, C., Dernellis, J. and Toutouzas, P. (1999) Evaluation of Left Atrial Performance Using Acoustic Quantification. Echocardiography, 16, 117-125. https://doi.org/10.1111/j.1540-8175.1999.tb00792.x
[15]
Farzaneh, A., Ariyarajah, V., Kaminski, M., Brown, K., Kwong, R., et al. (2011) Left Atrial Passive Emptying Function during Dobutamine Stress MR Imaging is a Predictor of Cardiac Events in Patients with Suspected Myocardial Ischemia. Journal of the American College of Cardiology, 4, 1936-1987. https://doi.org/10.1016/j.jcmg.2011.01.009
[16]
Bonow, R.O., Kent, K.M., Rosing, D.R., et al. (1982) Improved Left Ventricular Diastolic Filling in Patients with Coronary Artery Disease after Percutaneous Transluminal Coronary Angioplasty. Circulation, 66, 1159-1167. https://doi.org/10.1161/01.CIR.66.6.1159
[17]
Hirota, Y. (1980) A Clinical Study of Left Ventricular Relaxation. Circulation, 62, 756-763. https://doi.org/10.1161/01.CIR.62.4.756
[18]
Aroesty, J.M., McKay, R.G., Heller, G.V., Royal, H.D., Als, A.V. and Grossman, W. (1985) Simultaneous Assessment of Left Ventricular Systolic and Diastolic Dysfunction during Pacing-Induced Ischemia. Circulation, 71, 889-900. https://doi.org/10.1161/01.CIR.71.5.889
[19]
Pellicori, P., Zhang, J., Lukaschuk, E., Joseph, A.C., Bourantas, C.V., Loh, H., Bragadeesh, T., Clark, A.L. and Cleland, J.G. (2014) Left Atrial Function Measured by Cardiac Magnetic Resonance Imaging in Patients with Heart Failure: Clinical Associations and Prognostic Value. European Heart Journal, 36, 733-742. https://doi.org/10.1093/eurheartj/ehu405
[20]
Matteo, C., Matteo, L., Francesca, M.R. and Sergio, M. (2012) Novel Echocardiographic Techniques to Assess Left Atrial Size, Anatomy and Function. Cardiovascular Ultrasound, 10, Article No. 4. https://doi.org/10.1186/1476-7120-10-4
