0181: Interest of atrial function assessment by tissue Doppler imaging in coronary patients

Abstract

Atrial function is an integral part of cardiac function which is often neglected. The presence of coronary artery disease may impair atrial function. This study investigated if atrial mechanical dysfunction was present in coronary patients by tissue Doppler echocardiography (TDI). : Prospective study in 60 patients hospitalized for coronary heart disease that we compared to 40 healthy subjects matched for age and sex. With pulsed TDI we measured the peak velocity of atrial contraction (Va) at the free wall of the RA (RA-Va), the LA (LA-Va) and in the inter-atrial septum (Va-IAS). We studied the electromechanical delay of the onset, the peak and the end of atrial contraction by measuring respectively the time between the beginning of the P wave and the onset, the peak and the end of atrial contraction. The mean age was 53.5±10.9 years [26;76] comparable to the average age of witnesses. 90% of the population was male. Va was similar in the free wall of the RA and LA (p=0.1) and less on the IAS (p<0.001) respectively 14.9±3.5 cm/s, 14.1±3.8 cm/s and 10.9±2.6 cm/s. In coronary patients, there are a significant decrease in the rate of atrial contraction in the three atrial sites (Va-LA:11.5±4 cm/s Vs 14.1±3.8 cm / s; Va-RA:12,4±3.7 cm/s Vs 14.9±3.5 cm/s; Va-AIG: 8.8±2.7 cm/s Vs 10.9± 2.6 cm/s, p<0.001). Similarly, there's a significant lengthening (p<0.001) in the electromechanical delay affecting the onset (RA:67.3±17.9 ms Vs 50±11.9 ms; IAS:73.1±18.3 ms Vs 59.3±15.9 ms; LA: 81.3±17.7ms Vs 55.4±13.1ms), the peak (RA: 127.2±23 ms Vs 110.3±27 ms; IAS: 130.2±18,3 ms Vs 120±17.4 ms; LA:138.1±17.3 ms Vs 126.8±17.4 ms) and the end (RA:196.8±25.7 ms Vs 175.6±25.3ms; IAS: 195±22.2 ms Vs 179.6±16.4 ms; LA:195.5±22.8 ms Vs 177.6±23 ms) of the atrial contraction. We found that the Va-LA is independent of the presence or absence of a trans-wall myocardial infarction. The atrial contractile dysfunction on echocardiography can help to establish the positive diagnosis of myocardial ischemia and to assess its severity. Pulsed TDI can make a better understanding of the impact of coronary heart disease on the sequence of mechanical atrial contraction.