Assessment Of Left Atrial Function Research Articles

Assessment of left atrial function in dilated cardiomyopathy patients using speckle-tracking echocardiography

Background: The available methods to assess left atrial function (LAF) have some limitations as angle dependence and opposite distortion. The objective of the current study was to evaluate LAF in dilated cardiomyopathy (DCM) of ischemic (IDCM) and non-ischemic etiologies (NIDCM) using speckle tracking echocardiography (STE).
 Methods: 52 patients with systolic heart failure were included in our study; 27 with IDCM and 25 with NIDCM along with 15 healthy controls. All patients underwent conventional echocardiography, tissue doppler imaging, and speckle tracking echocardiography. The later modality was used to compare left atrial function in IDCM and NIDCM groups.
 Results: We found the left atrial maximum volume and the left atrial total emptying volume to be higher in patients with dilated cardiomyopathy compared to healthy patients (52.19 ± 6.01 vs. 21.87 ± 1.69 cm3/m2; p <0.001 and 28.67 ± 4.34 vs. 15.67 ± 2.02 cm3/m2, respectively). Conversely, left atrial emptying index and left atrial active ejection fraction were lower in patients with DCM compared to healthy controls (9.60 ± 2.29 vs. 8.27 ± 3.01 cm3/m2; p< 0.001 and 23 ± 2.56 vs. 37.47 ± 3.54 %; p<0.001, respectively). When comparing the IDCM group with NIDCM patients, we found no significant difference in left atrial maximum volume and left atrial active emptying volume. However, the NIDCM patients had significantly lower left atrial total emptying volume, and left atrial active ejection fraction (8.93 ± 1.86 vs. 9.60 ± 2.29 cm3/m2 and 23 ± 2.56 vs. 31.19 ± 1.66 %; p<0.001). on comparing strain function, DCM patients had lower systolic (28.22 ± 3.84 vs. 60.87 ± 3.07 %, p<0.001), and left atrial systolic strain rate (-2.66 ± 0.45 vs. -3.81 ± 0.35; p = 0.003) compared to healthy controls. All strains and strain rates were significantly lower in NIDCM patients compared to IDCM patients.
 
 Conclusion: STE is a promising method for evaluating LAF in DCM patients. Patients with DCM had significantly lower left atrial systolic and late diastolic strains and strain rates compared to healthy patients. Moreover, NIDCM could be differentiated from IDCM by having more impairment in the LA dynamic reservoir and booster pump function.

Assessment of left atrial function in patients with ischemic and nonischemic dilated cardiomyopathy using speckle-tracking echocardiography

Objective The aim was to assess left atrial (LA) function in patients with ischemic and nonischemic dilated cardiomyopathy using speckle tracking echocardiography. Background LA changes occur in patients with dilated cardiomyopathy and LA enlargement is commonly found by echocardiography. Two-dimensional speckle tracking echocardiography is a tool for the evaluation of LA function. Patients and methods This casecontrol study was conducted on 67 randomly selected individuals who presented to the Cardiology Department of Faculty of Medicine, Menoufia University, Egypt, during the period from January 2017 to December 2017. They included 52 patients with systolic heart failure (HF) and 15 normal individuals. In this study, the LA maximum, minimum volumes, and volume before the atrial systole, and calculated total emptying, active emptying volumes, expansion index, and fraction were measured. Strains and strain rates during left ventricular (LV) systole and late LV diastole using speckle-tracking imaging were measured. Results The study showed no significant differences between the nonischemic dilated cardiomyopathy (NIDCM) and ischemic dilated cardiomyopathy (IDCM) groups in the A peak, DT, septal e′, E/A, E/e′ and LAD, LVEDD. LA maximum volume (LAVmax) and the active emptying volume of LA (LAEV) showed no significant difference between the studied groups, but the total emptying capacity of the LA (LATV), the left atrial expansion index, and the left atrial active ejection fraction (LAAEF) were significantly lower in the NIDCM group. The LA strain and strain rate during LV systole (Ss, SRs) and during late LV diastole (Sa, SRa) representing the reservoir and booster pump function of the LA, respectively, were significantly lower in the NIDCM group. Conclusion LA systolic and late diastolic strains and strain rates were significantly lower in NIDCM patients. The LA dynamic reservoir and booster pump function were more severely impaired in NIDCM.

P1797 Left atrial mechanics in patients with stoke: Implications for emprical anticoagulation

Abstract Purpose Detection of atrial fibrillation (AF) after stroke impacts patient management. However, detection of AF is difficult due to its paroxsysmal nature. We sought to test the hypothesis that echocardiographic quantification left atrial (LA) mechanics in patients with stoke can be an imaging biomarker to predict AF. Methods We enrolled prospectively and consecutively 131 patients in normal sinus rhythm with a new diagnosis of ischemic stroke. All patients underwent 48-hour Holter monitorization, transthoracic echocardiography with saline injection in addition to routine work-up of stroke evaluation. Two-dimensional and Doppler studies, together with most up-to-date LA quantification tools were performed including 3-dimensional LA phasic volumes (maxiumum and minimum LA Volume index - LAVImax, LAVImin) and LA strain quantification (average strain from apical 4- and 2-chamber during reservoir (Ss) and contraction (Sa) phases). Patients were followed-up and underwent second 48-hour Holter monitorization 6-12 months later if no etiologic cause was found. Any AF episode lasting >30 seconds was considered significant parosysmal AF. Results In 49 patients, causes other than AF were identified (Noncryptogenic). In 43 patients no discernable cause was found (NoAF Cryptogenic). Paroxysmal AF episodes lasting longer than 30 sec were documented in 27 patients at first 48-hour Holter and in 12 patients during follow-up (9.2 ± 3.1 months) either by second 48-hour Holter monitorization or clinically (AF cryptogenic). LAVImax and LAVImin were significantly increased, Ss and Sa were significantly reduced in patients with AF as compared to No AF and Noncryptogenic groups (Table). LA volumes and strain measures predicted AF development independently of CHA2DS2-VASc score. Better discrimination between No AF and AF groups was obtained after second Holter monitorization that enabled detection of more cases with paroxysmal AF (Figure). Conclusions Our findings underscore the value of echocardiographic assessment of LA function as a marker of AF development and for selection of patients who could benefit from empiric anticoagulation. Noncryptogenic AF cryptogenic No AF cryptogenic 3D LAVI max (ml/m²) 30.1 ± 9,4 38.1 ± 12.7 28.9 ± 9.2 3D LAVI min (ml/m²) 13.9 ± 7.5 20.7 ± 10.7 13.4 ± 5.3 3D LA EF (%) 55.5 ± 9.4 50.0 ± 10.5 53.8 ± 10.0 Ss (%) 17.4 ± 8.5 12.7 ± 5.3 17.5 ± 8.5 Sa (%) 12.7 ± 6.3 9.0 ± 5.0 12.8 ± 6.3 CHA2DS2-VASc 4.0 ± 1.6 5.0 ± 1.6 3.9 ± 1.5 Abstract P1797 Figure.

Effect of end-stage liver disease on left atrial function

Background Hepatic cirrhosis causes structural and functional myocardial changes. Parameters of left atrial (LA) function provided novel insights and have prognostic significance in many cardiac patients. 2D speckle tracking echocardiography and tissue Doppler imaging (TDI) technique supported a comprehensive method for examining the LA function. The aim of this study was to investigate phasic LA functions in end-stage hepatic cirrhosis using echo-Doppler and strain imaging techniques in participants with preserved left ventricular (LV) ejection fraction. Patients and methods This study included 50 patients with end-stage hepatic cirrhosis based on Child-Pugh score having normal LV systolic function, in addition to 35 healthy individuals as a control group. All the studied cases underwent LV conventional echo-Doppler imaging measurements and LA dimensions and volumetric measurements, together with TDI-derived left atrial strain (TDLA strain), speckle tracking echo-derived left atrial global strain (LAGST), and peak LA systolic myocardial velocity (LA Sm4) averaged from 4 LA myocardial sites. Results There was a highly significant increase of LVIDd and LVIDS and significant increase of MA vel in group I, whereas there was a highly significant decrease of ME vel and ME/A ratio in group I. Group I had highly significant increase in LA dimensions (anteroposterior and superior inferior) and significant increase in LA mediolateral diameter. Moreover, there was a significant increase in LA volumes and volumic indices (LAVmax, LAVI, LAVmin, LAVI min, LAV pre-A, and LAVI pre-A) in group I. Conclusion LA function is impaired in patients with end-stage liver disease. 2D strain and TDI-derived strain are useful echomodalities for assessment of LA function.

409 Left atrial pump function assessed by speckle tracking echocardiography adds important value for the diagnosis of heart failure with preserved ejection fraction

Abstract Funding Acknowledgements “This work was supported by a grant of Ministery of Research and Innovation, CNCS-UEFISCDI, project number PN-III-P1-1-TE-2016-0669, within PNCDI III” Background Differentiation between heart failure with preserved ejection fraction (HFpEF) and isolated diastolic dysfunction (DD) at rest is crucial, since the prognosis is different. Symptoms are often non-specific, while NTproBNP might not be available. Increased NTproBNP is predicted by none of the currently used transthoracic echocardiographic (TTE) parameters. However, assessment of left atrial (LA) function by speckle tracking echocardiography (STE) might be a potential new marker of increased LV filling pressure. Aim. To assess LA function by STE in HFpEF and DD, on top of the currently used TTE parameters, in order to establish the added value of LA deformation in the diagnosis of HFpEF. Methods 70 patients were enrolled prospectively: 40 with HFpEF (68 ± 9 yrs) and 30 with DD (60 ± 10 yrs). TTE was used to assess LV ejection fraction (LVEF), E/E’ ratio, left atrial volume index (LAVi), and systolic pulmonary arterial pressure (sPAP). STE was used to assess LA functions: reservoir function by strain from MVC to MVO (LASr) and positive strain rate (LASRr), conduit function by strain from MVO to onset of atrial contraction (LAScd) and early negative strain rate during conduit phase (LASRcd), and LA pump function by negative strain at MVC (LASct) and late negative strain rate during atrial contraction phase (LASRct). NTproBNP was measured in all patients. Results HFpEF patients had significantly higher LVEF, NTproBNP, E/E’ ratio, and sPAP, but similar LAVi compared to DD, suggesting higher LV filling pressure (Table). LA reservoir and conduit function were similar. However, LA pump function was significantly lower in HFpEF, expressed by LASRct (Tabel). NTproBNP correlated with E/E’ ratio, sPAP, and LASRct (all r = 0.44, p < 0.001), but not with LAVi. By multiple regression analysis, best predictor for NTproBNP > 125pg/ml was LASRct (r = 0.60, r2 =0.30, p < 0.001). LASRct < -1.29 (AUC = 0.82, sensitivity 75%, specificity 81%) was the only predictor of NTproBNP > 125pg/ml (Figure). Conclusion LA pump function is the only predictor of NTproBNP > 125pg/ml. This parameter should be incorporated in the current protocols for the diagnosis of HFpEF. Group (N) NTproBNP ng/ml LVEF (%) E/E’ sPAP (mmHg) LAVi (ml/m2) LASr (%) LASRr LAScd (%) LASRcd LASRct HFpEF (40) 329 ± 383 62 ± 6 10.4 ± 2.7 34 ± 11 40 ± 9 25 ± 4 1.28 ± 0.3 11.6 ± 5.5 -1.37 ± 0.5 -1.07 ± 0.6 DD (30) 37 ± 26 57 ± 8 7.5 ± 1.8 23 ± 7 39 ± 11 26 ± 6 1.26 ± 0.3 11.2 ± 3.6 -1.5 ± 0.6 -1.76 ± 0.7 P value 0.001 0.008 <0.001 <0.001 0.7 0.4 0.8 0.7 0.4 <0.001 Abstract 409 Figure.

Impact of left atrial appendage occlusion on left atrial function-The LAFIT Watchman study.

Left atrial (LA) strain and strain rate (SR) analysis by two-dimensional speckle tracking echocardiography is a novel way of LA function assessment. From prior study, we know that LA appendage closure with LARIAT appears to improve LA function. The purpose of this study was to assess the impact of LAA closure via Watchman device on LA function via strain and volumetric analyses using two-dimensional speckle tracking echocardiography(2D-STE). Twenty-five patients who underwent Watchman device implantation (WDI) were included. LA function parameters (volumetric, strain indices) were calculated from apical four chamber views with the reference point set at QRS using 2D-STE before and after WDI. LA expansion index, strain and strain rate during ventricular systole represent LA reservoir function. Passive emptying fraction, strain and strain rate during early ventricular diastole represent LA conduit function. Mean age was 76 ± 6.9years with 60% males. There was significant improvement in conduit function (LA passive emptying fraction; post 28.6 (21.9-35.9) vs pre 21.0 (13.8-34.7), p= 0.032), reservoir function (LA expansion index; post 75.3 (52.3-98.0) vs pre 58.1 (37.8-85.2), p= 0.026), and booster function (LA active emptying fraction; post 13.3 (9.7-29.9) vs pre 12.6 (8.8-25.5), p= 0.04) by volumetric indices. No significant improvement was noted with strain indices in conduit function (SRe; post - 0.56 (0.43-0.93) vs pre - 0.58 (0.46-0.87); p= 0.518) and reservoir function (SRs; post + 0.58 (0.28-0.40) vs pre + 0.52 (0.35-0.86); p= 0.851). WDI resulted in discrepancy of volumetric and strain indices in LA function assessment.

Left atrial functional and structural changes associated with ablation of atrial fibrillation - Cardiac magnetic resonance study.

Left atrial (LA) volumes are related to success of atrial fibrillation (AF) ablation, but the relation to other functional and structural parameters is less well understood. Our goal was to detect potential functional and structural predictors of arrhythmia recurrence after ablation using cardiac magnetic resonance imaging (CMRi) and to non-invasively assess the relation between LA functional and structural remodeling pre- and post-ablation. A total of 55 patients (38 male, age 67±10years) underwent CMRi prior to and then within 24-h and 3-months after ablation. LA volumes (LAV) and function (as assessed by ejection fraction and peak longitudinal atrial strain (PLAS)) were measured by feature-tracking CMRi, and LA fibrosis/scarring was quantified using late‑gadolinium enhancement (LGE) imaging. Atrial function was lower acutely in patients with recurrence versus those with non-recurrence: [R vs NR: EFTotal 27.8±10.3% vs 38.1±11% p=0.002; EFActive 10.5±8% vs 19.1±12% p=0.007; EFPassive 19.4±8 vs 25.8±10 p=0.021; PLAS 13±5.9% vs 20.2±7% p=0.004]. With univariate analysis, baseline minimum volume (MinLAV, MinLAVi), several baseline functional parameters (EFTotal, EFPassive, EFActive, PLAS), and LA-LGE were predictors of recurrence [all p<0.05]. Acute function (EFTotal, EFPassive, EFActive, PLAS) also predicted recurrence (p<0.01). Lower pre-ablation EFTotal, EFPassive, and PLAS correlated with higher amount of pre-ablation LA-LGE (p<0.05). In a multivariate model including MinLAV, EFActive and LA-LGE (all at baseline), LA-LGE was the only independent predictor of recurrence (p=0.0322). Pre-ablation function inversely correlated with LA-LGE and was related to success of AF ablation. Multi-parametric and longitudinal assessment of LA function and structure could be helpful in selection of optimal treatment strategies for AF patients by predicting outcomes.

Risk in atrial fibrillation: left atrial function matters

Risk in atrial fibrillation: left atrial function matters

Assessment of Left Atrial Function in Patients with Paroxysmal, Persistent, and Permanent Atrial Fibrillation using Two-Dimensional Strain.

Atrial fibrillation (AF) has a progressive nature, leading to structural, functional, and electrical changes in the left atrium (LA). Enhanced response to treatment in patients with AF can be achieved through improved knowledge of atrial structure and a better understanding of its function. The aim of this study was to assess LA strain and its determinants in patients with paroxysmal (PAF), persistent (PsAF), and permanent AF (PmAF). Fifty-eight patients with registered non-valvular AF were divided into 3 groups depending on the type of AF. The participants underwent transthoracic echocardiography to assess the anatomy and function of heart chambers. Left atrial longitudinal strain (LALS) was measured in four-chamber projections using two-dimensional speckle tracking echocardiography. Patients with PAF had higher LALS (15.7±12.0) when compared to those with PsAF (4.3±7.9) and PmAF (5.8±7.8, all P=0.003). Multiple linear regression showed that the independent predictors of LALS were diastolic blood pressure (β=0.95, R2=0.88) in the PAF group; left atrial area (β=-0.56) and creatinine (β=-0.63, R2=0.58) in the PsAF group; AF duration (β=0.89) in the PmAF group (R2=0.72). LA strain has different determinants depending on AF type. LA size, renal function, and AF duration determine LALS in long-lasting AF. LA strain is a simple and accurate technique to estimate LA dysfunction in patients with long-lasting AF.

P2460Prospective evaluation of atrial function by 2D Speckle Tracking analysis in HER-2 positive breast cancer patients during Trastuzumab therapy

Abstract Background Trastuzumab (TZ) is a key therapy for HER2+ breast cancer (BC) patients, with well known possible negative effect on left ventricular (LV) function. A decrease in LV global longitudinal strain (GLS) has been demonstrated to be a good predictor of subsequent TZ-related cardiotoxicity (CT). Early left atrial (LA) enlargement preceding LV dysfunction has also been documented. Limited data are available about LA function in this setting. Aim To investigate LA function by deformation indexes (strain rate) in BC patients treated with TZ. Methods HER-2 positive BC metastasis-free patients referring to our echo-lab were prospectively recruited. Patients underwent consecutive transthoracic echocardiography before starting TZ and then every 3 months, up to 12. LV volumes, LV ejection fraction (LVEF) with Simpson biplane methods, LA volume and diastolic parameters were measured; 2D-Speckle Tracking analysis was performed and GLS and peak atrial longitudinal strain (PALS) were analyzed using Philips' QLAB software. Different lab tests and clinical data were also collected. Results 64 patients formed the study population. 40 (62.5%) had a complete 12 months follow up (FU). 53 patients (82.8%) were previously treated with anthracyclines. Mean age was 55.05±12.1 years. CT, as defined by current ESC guidelines, occurred in 6 patients (9.3%). Mean GLS was −21.4±2% and mean baseline PALS was 51.1±12%. GLS analysis was feasible in 91% of patients and PALS analysis in 84%, with excellent reproducibility for GLS (intra-observer ICC 0.93, p=0.8; inter-observer ICC 0.83, p=0.7). Even if during FU cardiotoxicity showed a low prevalence, a drop in LVEF over time was anyway documented, with major worsening at 6 months. Our study confirms previous data reporting a trend of decrease in GLS (p for time = 0.06), with an early drop during the first six months of TZ therapy and a subsequent “plateau” phase; we also reported a significant decrease of PALS over time (p for time = 0.008), with a continuous gradual decrease for the whole FU. A significant positive correlation between baseline PALS and LVEF at 6 months follow up was shown (R2 0.2; p=0.006). Similar result was obtained analyzing the correlation between LAVI and LVEF at 6 months (R2 0,19; p=0,02). Conclusion 2D speckle tracking analysis is feasible and adds useful information about LV and LA functional remodeling. Actual recommendations for CT identification are based upon a joint evaluation of LVEF and GLS, but our study demonstrates that significant variations in GLS and PALS can occur independently of development of CT. Moreover baseline PALS and LAVI predict the trend of LVEF at 6 months of FU, time of the major mean LVEF drop documented. The assessment of LA function by deformation indexes (strain rate) could add further information for daily clinical practice, possibly improving the detection of early CT. More studies are needed to further investigate these exploratory data.

P2728Prognostic impact of left atrial function in patients with cardiac amyloidosis: a cardiac magnetic resonance study

Abstract Background Left atrial function (AEF) is a parameter of paramount importance that has a prognostic value in a number of heart conditions. Cardiac involvement in both light-chain and transthyretin amyloidosis is the main driver of prognosis and influences treatment strategies. Cardiac magnetic resonance (CMR) provides high quality images of the left and right atria using high temporal resolution steady state free precession (SSFP) cine sequences. Purpose The aim of our study was to assess by CMR left atrial function and his correlation with prognosis in patients with cardiac amyloidosis. Method We enrolled 80 consecutive patients with diagnosis of cardiac amyloidosis: 38 patients (47%) with light-chain and 42 patients (53%) with transthyretin one. CMR was performed using a 1.5-T scanner. In all subjects, the study of atria was obtained by acquiring cine steady-state free precession (SSFP). Left Atrial function was evaluated by the ratio between the maximum and the minimum LA volume. A median follow up of 937 days was performed and 36 patients (44%) died of cardiac causes. We evaluated cardiac death as endpoint. We split out all the patient in 4 different quartiles depending on left atrial function: in the first quartile patients with AEF≤14% that reflects severe atrial dysfunction, in the second quartile patients with AEF between 14 and 19%, in the third quartile patients with AEF between 19 and 36% and in the last one patients with AEF≥36% that represent patients with normal value of left atrial function. Results We found that CMR assessed left atrial function allowed to individuate and stratify the prognosis in patients with cardiac amyloidosis. The most effective parameter to evaluate cardiac death was left atrial function with a cut off ≤14% that could predict cardiac related mortality with the same accuracy in both light-chain and transthyretin amyloidosis patients. Kaplan Meier analysis showed that patients with AEF≤14% had a worse prognosis as compared to patient with AEF≥14% (log rank p. 0001). Furthermore patients with AEF≤14% have a cardiac death risk of 32% at 1 year and 61% at 3 years. Kaplan Meier analysis Conclusion Cardiac magnetic resonance is an imaging modality that allows to individuate with great accuracy left atrial function in patients with various heart conditions and especially cardiac amyloidosis. CMR left atrial function assessment clearly identifies a subgroup of cardiac amyloid patients with an increased risk of death.

Left Atrial Mechanical Function and Incident Ischemic Cerebrovascular Events Independent of AF: Insights From the MESA Study

ObjectivesThis study sought to assess the association of baseline left atrial (LA) phasic function measured with cardia magnetic resonance (CMR) and incident ischemic cerebrovascular events (CVE). BackgroundLA remodeling is a known predictor of atrial fibrillation (AF), which is a risk factor for ischemic CVE. Despite studies showing an association between LA remodeling and ischemic CVE, the association of LA mechanical function with ischemic CVE in a population free of known cardiovascular disease is not fully studied. MethodsPhasic LA volumes; total, passive, and active LA emptying fractions (LAEF); and peak longitudinal LA strain were measured using feature-tracking CMR in 4,261 MESA (Multi-Ethnic Study of Atherosclerosis) participants (61 ± 10 years of age; 48% male). All individuals were free of clinical cardiovascular disease at baseline. Participants were followed for 11.6 ± 3.5 years for the diagnosis of incident ischemic CVE, defined as ischemic stroke or transient ischemic attack adjudicated by vascular neurologists. ResultsDuring the follow-up, 193 (1.26 per 1,000 person-years) ischemic CVE (134 ischemic strokes and 59 TIAs) occurred. Individuals with incident ischemic CVE had larger LA volumes and lower passive, active, and total LAEFs at baseline. In multivariate analysis adjusted for known CVE risk factors, left ventricular mass and interim AF, total LAEF was associated with incident ischemic CVE (hazard ratio [HR]: 0.85 per SD; 95% confidence interval [CI]: 0.74 to 0.98; p = 0.027). The unadjusted HR for the lowest tertile of total LAEF compared to the highest tertile was 2.0 (95% CI: 1.43 to 2.79; p < 0.001), and the adjusted HR was 1.47 (95% CI: 1.04 to 2.05; p = 0.031). Addition of total LAEF to known clinical risk factors of CVE and left ventricular mass resulted in an improved predictive accuracy (C statistic of 0.76 vs. 0.73, respectively; p = 0.039). ConclusionsReduced total LAEF was associated with incident ischemic CVE independent of known cerebrovascular risk factors and incident AF. Assessment of LA function may add further information in stratifying asymptomatic individuals at risk for ischemic stroke.

Strain/Strain Rate Imaging of Impaired Left Atrial Function in Patients with Metabolic Syndrome

Background: Metabolic syndrome (MS) predisposes to left ventricular dysfunction and heart failure, however, alterations in left atrial (LA) function in MS are unknown. Objectives: We aimed to use strain/strain rate (SR) imaging to investigate the effect of MS on LA function. Subjects and Methods: This prospective case control study included a total of 100 subjects divided in to 75 metabolic syndrome (MS) patients referred to Al-Azhar university hospital outpatient clinic for evaluation and treatment of hypertension and/or diabetes mellitus and 25 age and sex matched apparently healthy volunteers as a control group. All subjects underwent conventional echocardiographic examination and assessment of LA function by speckle tracking. Partial correlation and multiple stepwise regression analyses were used to determine the risk factors for impaired LA function. Results: Compared with the controls, the MS patients showed significantly lower levels of mean strain, mean peak systolic SR and mean peak early diastolic SR (P<0.05 for all), with no difference in the mean peak late diastolic SR. Central obesity, hypertension, dyslipidemia and uncontrolled diabetes were independent risk factors for impaired LA function. Conclusion: SR imaging is reliable in assessing LA function in MS patients.

Left Atrial Dynamics During Exercise in Mitral Regurgitation of Primary and Secondary Origin: Pathophysiological Insights by Exercise Echocardiography Combined With Gas Exchange Analysis

ObjectivesThe aim of this study was to identify the pattern of exercise left atrial (LA) dynamics, its gas exchange correlates, and prognosis in mitral regurgitation (MR) of primary and secondary origin. BackgroundThe adaptive response and clinical significance of LA function during exercise in MR is undefined. MethodsA total of 196 patients with MR (81 with primary MR, 115 with secondary MR) and 54 control subjects underwent exercise stress echocardiography and cardiopulmonary exercise testing with LA function assessment. Patients with MR were divided into 4 groups according to etiology and severity using a cutoff of 3+. ResultsLA dynamics was studied using speckle-tracking echocardiography. Compared with control subjects, patients with MR had a lower LA strain and strain rate at rest. Exercise LA strain and LA strain rate progressively worsened from primary MR <3+ through secondary MR ≥3+. In primary MR, some reserve in exercise LA strain and LA strain rate was observed, but not in secondary MR. In secondary MR, LA strain at rest and during exercise (18.1 ± 5.7 s−1, 18.3 ± 6.9 s−1, 18.6 ± 5.5 s−1, 13.9 ± 3.8 s−1) and peak oxygen consumption (11.7 ± 3 ml/min/kg) were decreased compared with the other groups. In secondary MR ≥3+, the slope of ventilation versus carbon dioxide was higher compared with the other groups: 35.1 (interquartile range [IQR]: 29.0 to 44.2) compared with control subjects: 26.5 (IQR: 24.4 to 29.0); patients with primary MR <3+ (26.9; IQR: 24.0 to 31.9); those with primary MR >3+ (25.5; IQR: 23.4 to 29.0); and those with secondary MR <3+ (29.5; IQR: 26.5 to 33.7) (p < 0.05 for all). A progressive impairment in exercise LA mechanics combined with limited cardiac output increase and right ventricular–to–pulmonary circulation uncoupling was observed from primary to secondary MR. LAS during exercise was predictive of all-cause mortality and hospitalization for heart failure. ConclusionsIn MR of any origin, exercise LA reservoir and pump function are impaired. For similar MR extent, secondary MR exhibits worse atrial function, resulting in the lowest exercise performance, limited cardiac output increase, impaired right ventricular–to–pulmonary circulation coupling, and the highest event rate.

Left Atrial Function Assessment in Patients with Rheumatic Mitral Valve Diseases

AbstractBackground: The assessment of Left Atrial (LA) function is used in various cardiovascular diseases. LA plays a com-plementary role in cardiac performance by modulating Left Ventricular (LV) function. Transthoracic two-dimensional (2D) phasic volumes and Doppler echocardiography can measure LA function non-invasively. However, evaluation of LA deformation derived from 2D Speckle Tracking Echocar-diography (STE) is a new feasible and promising approach for assessment of LA mechanics. These parameters are able to detect subclinical LA dysfunction in different pathological condition.Aim of Study: To assess left atrial function by conventional echo Doppler study and tissue Doppler based strain imaging as well as global longitudinal strain in patients with rheumatic mitral valve disease.Patients and Methods: A total of 50 rheumatic mitral valve disease patients appearing consecutively for echocardi-ogram (ECHO) test at the Cardiology Department in a tertiary care hospital were recruited into the study as per the pre-set inclusion and exclusion criteria. The data were pooled using Microsoft Excel and analysed using SPSS software by appli-cation of appropriate statistical tests.Results: Of the 50 subjects, 22 had Mitral Stenosis (MS), 14 had Mitral Regurgitation (MR), and 14 of them were found to have both MS and MR. The major presenting symptom as observed in 23 patients was dyspnea. LA functions were significantly reduced in double mitral lesion group which was observed in LA indices such as LA emptying fraction, LA passive emptying fraction, atrial fraction, and LA expansion index among groups.Conclusion: LA reservoir, conduit and contractile function were significantly affected in rheumatic mitral valve disease due to increased hemodynamic load. Global longitudinal strain was significantly reduced in patients with MS and MR.

Left Atrial Strain Performance and its Application in Clinical Practice

There is increasing evidence of the importance of left atrial (LA) function incremental to atrial dilatation. The feasibility of LA function assessment has increased with the development of LA strain [(1)][1]. Although the use of atrial strain is ready to spread beyond its research application, many

Reproducibility of Echocardiography in Assessing Left Atrial Reservoir Function in Rheumatic Mitral Valve Disease

Background: Although abnormal left atrial (LA) reservoir function had been associated with clinical events in patients with mitral valve disease, its routine assessment is not performed due to inaccuracies and difficult time-consuming measurements. Aim: The aim was to study the feasibility and reproducibility of different echocardiographic parameters for LA assessment in patients with rheumatic mitral valve disease. Methods: Two hundred and fifty-nine patients with mitral valve disease underwent full echocardiographic examination. LA reservoir function was measured by two-dimensional (2D) volumes, 3D volumes, and global longitudinal strain (LA GLS). LA GLS, volumes, and total left atrial emptying fraction values were repeated to obtain the intra- and interobserver variabilities. The latter was performed between a nonexpert and two expert examiners. Results: 3D echocardiography was highly feasible in assessing LA function, feasibility was 94%, and was performed in the shortest time (1.3 ± 0.4, ANOVA, P &lt; 0.0001). All LA 3D measurements showed excellent intraobserver and interobserver reproducibility between the two expert readers; coefficient of variation (CV) was 7% and 8%, respectively, for LA maximal volume index (LAVImax). Although CV for interobserver variability between the expert and nonexpert readers was 12% for 3D minimal LAVI (LAVImin), assessment of 2D LA volumes had the lowest reproducibility; CV was 15% for LAVImin. Conclusion: 3-d echocardiography assessment of LA volumes and function in patients with rheumatic heart disease is highly feasible and reproducible; it is easy to learn and can be easily performed by nonexperts.

Interatrial septal fat thickness and left atrial stiffness are mechanistic links between nonalcoholic fatty liver disease and incident atrial fibrillation.

Recently, a clear evidence suggests that nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of incident atrial fibrillation (AF). Yet, the underlying pathogenesis is speculative. Thereby, we aimed to investigate the hypothesis that, interatrial thickness (IAST) and left atrial stiffness (LASt) might have mechanistic links between NAFLD and AF. Echocardiography and speckle-tracking assessment of left atrial function, transient elastography (TE) of the liver, basal ECG, and Holter monitoring were performed in 180 patients with (NAFLD) and 80 subjects without NAFLD. Patients with NAFLD had higher values of IAST (P<0.001), LASt (<0.001), and E/e' ratio (<0.003) compared with controls. IAST was correlated with LASt (r=0.413; P<0.001). 15.6% of patients with NAFLD had AF. More so, patients with increased IAST/LASt had a higher incidence of AF (25%) vs 3.8% in those with normal IAST/LASt. The LASt and IAST increased significantly in those with AF compared with those without (P<0.001). Patients who experienced AF had higher values (P<0.01) of TE (kPa). The degree of liver stiffness TE (kPa) was correlated with both IAST and LASt (r=461, r=0.535; P<0.001). Furthermore, multivariate regression analysis showed that LASt and IAST were independent predictors of incident AF in subjects with NAFLD. Our data suggest that increased IAST and LASt index are independently associated with incident atrial fibrillation in patients with NAFLD. Increased IAST and LASt index might provide mechanistic links between NAFLD and incident atrial fibrillation.

Assessment of left atrial function in dogs with myxomatous mitral valve disease by biplane simpson’s method

ABSTRACT The relationship between the diameter of the left atrium (LA) and aorta (Ao) is considered as a prognostic factor in chronic mitral valve disease. As the left atrium is a three-dimensional structure, methods based on measurement of the chamber volume can be more accurate than linear methods.The aim of this study was to assess the feasibility of measuring LA volume with 2D echocardiography using the biplane modified Simpson (SIMP) method in 33 dogs with various classes of myxomatous mitral valve disease (MMVD), as well as to present values of LA function using the atrial diastolic and systolic volume indices (ADVI and ASVI), cardiac index (ACI) and atrial ejection fraction (AEF). We observed agreement among the LA/Ao ratio and the atrial volume indices (ADVI and ASVI) and the ACI, suggesting that the values of the variables increase as the LA/Ao ratio increases due to atrial remodeling that accompanies MMVD progression. The data demonstrated a good assessment of atrial function, allowing a better understanding of LA's role in the pathophysiology of MMVD.

Assessment of Left Atrial Function in Patients with Non-ST-Segment Elevation Myocardial Infarction Using Two-Dimensional Speckle Tracking Echocardiography

Background: the left atrium (LA) plays a major role in Left ventricular (LV) performance. LA function is a surrogate marker of LV diastolic dysfunction. LA mechanical dysfunction occurs in LV systolic and diastolic dysfunction, coronary artery disease, myocardial infarction (MI), hypertension, aortic stenosis and cardiomyopathies. In the MI process, the contribution of the LA to LV function may increase if the cardiac myocytes are not affected by direct ischemia. However, myocyte necrosis or ischemia of the LA or significant LV systolic/diastolic dysfunction affects this booster effect. Assessment of LA size and function provides prognostic data for the outcome of patients with MI or ischemia. Aim of the Study: was to evaluate LA function in patients with non-ST-segment elevation myocardial infarction (NSTEMI) by two-dimensional speckle tracking echocardiography (2D STE). Patient and Methods: 60 patients with NSTEMI and 20 age-matched normal control individuals were enrolled in this study. Conventional echocardiographic parameters and global longitudinal strain rate (GLSR) were measured at left ventricular (LV) and LA segments. Results: Compared with healthy subjects, patients with NSTEMI had significantly increased LA volumes but significantly decreased LA emptying fraction and GLSR. LA-GLSR had significant correlations with the 2D Doppler echocardiographic parameters of LA function. In particular, global LA peak negative strain rate during early ventricular diastole (LA-GLSRe) was significantly correlated with both LA 2D Doppler echocardiographic parameters and LV contractile function. This could be suggested as a better indicator to evaluate LA function as a preferred parameter of STE. Conclusion: It could be concluded that two-dimensional speckle tracking echocardiography represented a non-invasive, relatively simple and reproducible technique to assess left atrial myocardial function in patients with NSTEMI.