Abstract
The left and right atria serve as buffer chambers to control the flow of venous blood for ventricular filling. If an atrium is absent, blood does not flow effectively into the ventricle, leading to venous blood retention and low cardiac output. The importance of atrial function has become increasingly recognized, because left atrial (LA) function contributes to cardiac performance, and loss of LA function is associated with heart failure. LA volume change has been used for LA function assessment in experimental and clinical studies. In conjunction with LA pressure, the LA pressure–volume relationship provides a better understanding of LA mechanics. LA strain measurement by speckle tracking echocardiography was introduced to evaluate three components of LA function as a (booster) pump, reservoir and conduit. Furthermore, increasing evidence supports the theory that LA reservoir strain has prognostic utility in various cardiac diseases. In this review, we summarize LA contribution to maintain cardiac performance by evaluating LA function with echocardiography according to our experiences and previous reports. Furthermore, we discuss LA dysfunction in challenging cardiac diseases of cardiac amyloidosis and adult congenital heart disease.
Highlights
The atria work as buffer chambers to receive blood from the venous system in a controlled manner and to effectively deliver it to the ventricles
We summarize left atrial (LA) contribution to prevent heart failure by evaluating LA function with echocardiography according to our experiences and previous reports
When we focus on LA reservoir function, the left atrium works as a reservoir to maintain cardiac output
Summary
The atria work as buffer chambers to receive blood from the venous system in a controlled manner and to effectively deliver it to the ventricles. If an atrium is absent, the ventricle carries a considerable hemodynamic burden to maintain cardiac performance. Under such circumstances, preservation of cardiac output depends only on ventricular systolic and diastolic function; otherwise, forward flow is unavoidably produced by an increased pressure in the upper venous system. When the pressure in the pulmonary vein is elevated to force a forward flow into a failing left ventricle, patients complain of heart failure symptoms, such as shortness of breath and dyspnea on exertion. The left atrium contributes to cardiac performance through three components, functioning as a (booster) pump, reservoir and conduit. The importance of the atrial contribution to cardiac function has become increasingly recognized in clinical practice. We discuss LA dysfunction in challenging cardiac disorders of cardiac amyloidosis and adult congenital heart disease (ACHD)
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