Abstract
BackgroundThe appropriate evaluation of atrial electrical function is only possible by means of invasive electrophysiology techniques, which are expensive and therefore not suitable for widespread use. Mechanical atrial function is mainly determined from atrial volumes and volume-derived indices that are load-dependent, time-consuming and difficult to reproduce because they are observer-dependent.AimsTo assess the feasibility of tissue velocity echocardiography (TVE) to evaluate atrial electromechanical function in young, healthy volunteers.Subjects and methodsWe studied 37 healthy individuals: 28 men and nine women with a mean age of 29 years (range 20–47). Standard two-dimensional (2-D) and Doppler echocardiograms with superimposed TVE images were performed. Standard echocardiographic images were digitized during three consecutive cardiac cycles in cine-loop format for off-line analysis. Several indices of regional atrial electrical and mechanical function were derived from both 2-D and TVE modalities.ResultsSome TVE-derived variables indirectly reflected the atrial electrical activation that follows the known activation process as revealed by invasive electrophysiology. Regionally, the atrium shows an upward movement of its walls at the region near the atrio-ventricular ring with a reduction of this movement towards the upper levels of the atrial walls. The atrial mechanical function as assessed by several TVE-derived indices was quite similar in all left atrium (LA) walls. However, all such indices were higher in the right (RA) than the LA. There were no correlations between the 2-D- and TVE-derived variables expressing atrial mechanical function. Values of measurement error and repeatability were good for atrial mechanical function, but only acceptable for atrial electrical function.ConclusionTVE may provide a simple, easy to obtain, reproducible, repeatable and potentially clinically useful tool for quantifying atrial electromechanical function.
Highlights
The enlargement of left atrial (LA) diameter is associated with cardiovascular disease and is a risk factor for atrial fibrillation, stroke and death. [1,2,3,4,5,6] LA function reliably predicts exercise capacity in patients with recent myocardial infarction[7] or non-ischemic dilated cardiomyopathy[8] and differs in patients with ischemic and dilated cardiomyopathy.[9]
Atrial electrical function has been evaluated from resting electrocardiography (ECG), and more accurately by invasive electrophysiology techniques. [32,33,34] The rapid development of these invasive techniques has improved diagnostic capabilities,[35,36] and our understanding of how the electrical impulse spreads through atrial tissues,[37,38] and has led to improvements in the treatment of supraventricular tachy-arrhythmias. [38,39,40] the invasive nature and the high costs of these procedures limit their widespread use and repeatability
No differences were found between measures of right atrium (RA) and LA functions, as assessed by short or long axes, or among volumes and volumederived indices
Summary
The enlargement of left atrial (LA) diameter is associated with cardiovascular disease and is a risk factor for atrial fibrillation, stroke and death. [1,2,3,4,5,6] LA function reliably predicts exercise capacity in patients with recent myocardial infarction[7] or non-ischemic dilated cardiomyopathy[8] and differs in patients with ischemic and dilated cardiomyopathy.[9]. Tissue velocity echocardiography (TVE) has been developed as a valuable tool for the evaluation of left and right ventricular systolic and diastolic functions.[26,27] this technique has been used to assess the regional functions of the left and right atrium.[28,29] atrial anatomy was described more than a century ago, a new interest in atrial anatomy and its relations with atrial electromechanical function has only recently emerged.[30,31] Conventionally, atrial electrical function has been evaluated from resting electrocardiography (ECG), and more accurately by invasive electrophysiology techniques. We aimed here to find simple and repeatable methods to assess both electrical and mechanical regional atrial functions by means of TVE. Mechanical atrial function is mainly determined from atrial volumes and volume-derived indices that are load-dependent, time-consuming and difficult to reproduce because they are observer-dependent
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