Atrial Ejection Force Research Articles

Left Atrial Ejection Force as a Novel Technique in the Diagnosis of Heart Failure With Preserved Ejection Fraction

Left Atrial Ejection Force as a Novel Technique in the Diagnosis of Heart Failure With Preserved Ejection Fraction

CRT-400.08 Left Atrial Ejection Force as a Novel Technique in the Diagnosis of Heart Failure With Preserved Ejection Fraction

CRT-400.08 Left Atrial Ejection Force as a Novel Technique in the Diagnosis of Heart Failure With Preserved Ejection Fraction

Association of left atrial ejection force and obesity: A prospective study of middle-aged adults

Association of left atrial ejection force and obesity: A prospective study of middle-aged adults

Clinical Study on Long-Term Sinus Reversion Rate and Left Atrial Function Recovery of Mitral Valve Disease with Atrial Fibrillation under Modified Surgical Radiofrequency Ablation.

We aimed to study the long-term sinus reversion rate and recovery of left atrial function after modified surgical radiofrequency ablation for permanent atrial fibrillation caused by mitral valve disease. From March 2014 to May 2020, 35 patients who underwent modified surgical radiofrequency ablation during cardiac valve surgery in our hospital were selected as the study group, and 25 normal individuals without cardiac structural changes were selected as the control group. The time of modified surgical radiofrequency ablation and long-term sinus reversion rate were measured, and left atrial anteroposterior, superoinferior, left and right diameters, left atrial ejection fraction, left atrial filling index, and left atrial ejection force were measured before and 6 months after surgery. The mean ablation time was 23.2 min, and the long-term sinus reversion rate was 80.0%. The left atrium diameter decreased and the left atrium ejection fraction increased after the operation (P < 0.05). The left atrium filling index and ejection force were significantly increased in 28 patients with sinus reversion (P < 0.05). The decrease in left atrial diameter and the increase in left atrial ejection fraction were correlated with sinus conversion after surgery (P < 0.05). The modified operation is simple, the curative effect is definite, and the sinus reversion rate is high, which is beneficial to the restoration of left atrial structure, ejection function, and hemodynamic function.

Left Atrial Ejection Force as a Marker for the Diagnosis of Heart Failure with Preserved Ejection Fraction.

Introduction:Several echocardiographic techniques are used to diagnose heart failure with preserved ejection fraction (HFPEF). Left atrial ejection force (LAEF) is a measure of left atrial (LA) systolic function. The aim of this study was to examine the use of LAEF as a measure for the diagnosis of HFPEF.Methods:A prospective study including 100 patients with HFPEF and 100 healthy controls. Heart failure association algorithm score for the diagnosis of HFPEF (HFA–PEFF score) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were assessed. Transthoracic echocardiography measured indexed left ventricular mass index (LVMI), left ventricular (LV) ejection fraction, LA volume index (LAVI), global longitudinal strain (GLS), trans-mitral Doppler velocities, E/A ratio, E/e' ratio, and estimation of LAEF.Results:Patients in the HFPEF group were more frequently hypertensive, diabetic, and had a history of ischemic heart disease. NT-pro-BNP was higher in the HFPEF group (P < 0.0001). LVMI, relative wall thickness, and LAVI were all significantly higher in the HFpEF group (P < 0.0001 for all). LV-GLS was significantly lower in the HFPEF (P < 0.0001). LAEF was significantly higher in the study group 142.14 ± 24.27 versus 92.18% ±13.99% (P < 0.0001). A sub-group of 18 patients in the study group with a borderline HFA-PEF score of 4 had a LAEF that was significantly higher than the control group (P < 0.0001) but did not differ from the rest of the HFPEFF group patients.Conclusion:LAEF was significantly higher in patients with HFPEF compared to healthy controls. Patients with a borderline HFA-PEFF score of 4 had a significantly higher LAEF as compared to controls.

The Effect of Transcatheter Atrial Septal Defect Closure on Left Heart Function in Pediatric Patients.

The aim of this study was to use tissue Doppler imaging to evaluate the left atrial systolic and the left ventricular (LV) diastolic function as well as the left atrial ejection force in children who underwent transcatheter closure of a secundum atrial septal defect (ASD). Tissue Doppler measurements of the left atrial ejection force, the mitral valve, and left atrial volume were performed before the ASD closure procedure, and on the 1st day, 10th day, and 1st and 3rd months after the procedure in 56 patients and in 28 healthy controls. There was a significant decrease in the septal and lateral a' velocities on the first day (p<0.05). There was a statistically significant increase in the septal e'/a' parameters at the third month compared with the initial measurements. The left atrial ejection force was lower in patients with an ASD than in the healthy group (10.69±4.94 kdyn, 12.31±4.05 kdyn, respectively), but there was no significant difference (p=0.053). The left atrial ejection force was significantly greater in the patient group 3 months after the procedure, and there was no significant difference compared with the control group. Improvement in the LV diastolic and left atrial systolic functions was observed in children who underwent transcatheter closure of an ASD. There was no negative effect related to the devices used.

Increased atrial contraction contribution to left ventricular filling during early septic shock

PurposeTo assess the atrial systolic function and the contribution of atrial contraction to left ventricular (LV) filling in septic shock patients as compared with healthy volunteers. MethodsTwenty-seven septic patients evaluated during first 48 h of ICU admission and compared with 27 healthy volunteers. Left atrial (LA) contraction contribution to LV filling was calculated as the active emptying atrial volume/LV end-diastolic volume. Atrial systolic function was evaluated with the atrial kinetic force [LAKE = 0.5 × blood density × LVVactive × (peak A velocity)2] and atrial ejection force [LASF = 0.5 × blood density × mitral annulus area × (peak A velocity)2]. ResultsLV ejection fraction was lower in septic patients than in control group: 51 ± 14%vs 60 ± 6% (p < 0.01). Contribution of LA contraction to LV preload was greater in septic patients than in normal subjects (26.7 ± 11.3% vs 15.9 ± 5.9%, p < 0.001), even if adjusted for age (0.49 ± 0.19 vs 0.35 ± 0.13, p = 0.004). LAKE and LASF were also significantly larger in septic patients than in normal subjects (21.8 ± 9.1 vs 7.3 ± 3 kdynes·cm, p < 0.001; 16.1 ± 11.7 vs 9.8 ± 4.3 kdynes, p = 0.048, respectively), and remained unchanged during the next 48 h. ConclusionIn septic shock patients, LA systolic function increased and greatly contributed to support LV filling. These results highlight the role of preserving atrial contraction on the hemodynamic resuscitation in early septic shock.

Atrial and ventricular ejection force of the fetal heart: Which of the four chambers is the dominant?

Background/Aim:This study aimed to measure and compare the ejection force of the cardiac chambers in healthy singleton fetuses and to investigate the relationship of ejection force of cardiac chambers with gestational age, fetal sex, and fetal heart rate.Patients and Methods:A prospective study was performed on 68 singleton fetuses with a gestational age of 17–34 weeks. Atrial and ventricular ejection force was measured. Measurements were repeated in 18 of the fetuses to assess intraobserver reliability.Results:The right atrium had the highest ejection force of all the cardiac chambers. Ejection force of both atria and ventricles increased with gestational age.Conclusion:The right atrium is the dominant chamber of the fetal heart in 17–34 weeks of gestation. Comparison of our values with previous studies indicates that left atrial ejection force almost doubles in the 1st month after birth. This study highlights the crucial role of the right atrium in the fetal cardiac function during 17–34 weeks of gestation.

Left atrial size and contractile function in healthy dogs and dogs with chronic mitral valve disease

ABSTRACT: In humans, left atrial enlargement and reduced contractile functions are associated with adverse cardiovascular events and a poor prognosis in many dilatation of the left atrium occurs with the gradual evolution of chronic mitral valve disease and is well diseases. The left atrium is the most compromised cardiac chamber in dogs with chronic mitral valve disease (CMVD). Therefore, this study aimed to compare the main parameters of left atrial enlargement (left atrium/aorta ratio, left atrial diameter and volume indices) and contractile function (transmitral flow peak velocity A wave and time velocity integral, atrial fraction, and atrial ejection force) at different stages of valve disease, and correlate the left atrial diameter, volume, and contractile function indices with echocardiographic variables predictive of heart failure in dogs (transmitral flow peak velocity E wave, E wave/IVRT ratio, E wave/E´wave ratio, and E wave/A wave ratio). The results showed that progressive characterized by the left atrium/aorta ratio and left atrium volume index. The left atrial diameter and volume indices and left atrium/aorta ratio correlated positively with the transmitral flow peak velocity E wave and E wave/IVRT ratio, which are important indices of diastolic function. The left atrial contractile function indices increased as CMVD evolved. Except for the atrial fraction, the left atrial contractile function indices correlated with the left ventricular filling pressure indices.

Leftatrial ejection force predicts the outcome after catheter ablation for paroxysmal atrial fibrillation.

Left atrium (LA) systolic dysfunction is observed in the early stages of atrial fibrillation (AF) prior to LA anatomical change. We investigated whether LA systolic dysfunction predicts recurrent AF after catheter ablation (CA) in patients with paroxysmal AF. We studied 106 patients who underwent CA for paroxysmal AF. LA systolic function was assessed with the LA emptying volume=Maximum LA volume (LAVmax ) - Minimum LA volume (LAVmin ), LA emptying fraction=[(LAVmax - LAVmin )/LAVmax ] × 100, and LA ejection force calculated with Manning's method [LA ejection force= (0.5 × ρ × mitral valve area × A2 )], where ρ is the blood density and A is the late-diastolic mitral inflow velocity. Recurrent AF was detected in 35/106 (33%) during 14.6 ± 9.1 months. Univariate analysis revealed reduced LA ejection force, decreased LA emptying fraction, larger LA diameter, and elevated brain natriuretic peptide as significant variables. On multivariate analysis, reduced LA ejection force and larger LA diameter were independently associated with recurrent AF. Moreover, patients with reduced LA ejection force and larger LA diameter had a higher risk of recurrent AF than preserved LA ejection force (log-rank P=0.0004). Reduced LA ejection force and larger LA diameter were associated with poor outcome after CA for paroxysmal AF, and could be a new index to predict recurrent AF.

Left atrial ejection force correlates with left atrial strain and volume-based functional properties as assessed by three-dimensional speckle tracking echocardiography (from the MAGYAR-Healthy Study)

Introduction and ObjectiveThree-dimensional (3D) speckle tracking echocardiography (3DSTE) is a novel method for assessment of left atrial (LA) volumes and function without geometrical assumptions. 3DSTE allows detailed assessment of LA features including volume measurements, strain assessments and calculation of LA ejection force (LAEF). LA strain and volume-based functional parameters originate from the same 3D dataset, but assessment of LAEF requires more data including measurement of mitral annular dimensions and Doppler-derived inflow velocities. The present study was designed to find correlations between LAEF and 3DSTE-derived LA volume-based functional properties and strain parameters in healthy subjects. MethodsThe study population comprised 34 randomly selected healthy subjects (age 36.1±11.2 years, 15 men) in sinus rhythm, all of whom had undergone standard two-dimensional transthoracic Doppler echocardiographic study extended with 3DSTE. ResultsMitral annulus diameter-based LAEF correlated with global LA peak circumferential (r=0.39, p=0.02), longitudinal (r=0.32, p=0.05) and area (r=0.43, p=0.01) strain, total atrial stroke volume (r=0.30, p=0.05) and total atrial emptying fraction (r=0.31, p=0.05) characterizing (systolic) LA reservoir function and global LA 3D strain at atrial contraction (r=−0.44, p=0.01) and active atrial emptying fraction (r=0.36, p=0.04) characterizing (diastolic) LA contraction function (booster pump phase). ConclusionsComplex LA functional assessment can be provided by 3DSTE, including calculation of LAEF and volume-based and strain functional properties, with significant correlations between these parameters.

Left atrial ejection force correlates with left atrial strain and volume-based functional properties as assessed by three-dimensional speckle tracking echocardiography (from the MAGYAR-Healthy Study)

Introduction and ObjectiveThree-dimensional (3D) speckle tracking echocardiography (3DSTE) is a novel method for assessment of left atrial (LA) volumes and function without geometrical assumptions. 3DSTE allows detailed assessment of LA features including volume measurements, strain assessments and calculation of LA ejection force (LAEF). LA strain and volume-based functional parameters originate from the same 3D dataset, but assessment of LAEF requires more data including measurement of mitral annular dimensions and Doppler-derived inflow velocities. The present study was designed to find correlations between LAEF and 3DSTE-derived LA volume-based functional properties and strain parameters in healthy subjects. MethodsThe study population comprised 34 randomly selected healthy subjects (age 36.1±11.2 years, 15 men) in sinus rhythm, all of whom had undergone standard two-dimensional transthoracic Doppler echocardiographic study extended with 3DSTE. ResultsMitral annulus diameter-based LAEF correlated with global LA peak circumferential (r=0.39, p=0.02), longitudinal (r=0.32, p=0.05) and area (r=0.43, p=0.01) strain, total atrial stroke volume (r=0.30, p=0.05) and total atrial emptying fraction (r=0.31, p=0.05) characterizing (systolic) LA reservoir function and global LA 3D strain at atrial contraction (r=−0.44, p=0.01) and active atrial emptying fraction (r=0.36, p=0.04) characterizing (diastolic) LA contraction function (booster pump phase). ConclusionsComplex LA functional assessment can be provided by 3DSTE, including calculation of LAEF and volume-based and strain functional properties, with significant correlations between these parameters.

Assessment of Left Atrial Ejection Force in Patients with different Grades of Left Ventricular Diastolic Dysfunction

Assessment of Left Atrial Ejection Force in Patients with different Grades of Left Ventricular Diastolic Dysfunction Objective: To assess left atrial ejection force (LAEF) in patients with different grades of left ventricular (LV) diastolic dysfunction compared to traditional Doppler and tissue Doppler measurements. Methods: 120 patients enrolled into four equal groups (n=30), each group represented a different grade of LV diastolic dysfunction and 30 subjects with normal diastolic function. We assessed echocardiographic measurements of dimensions and diastolic function, LA volume index (LAVI), and LAEF and age-corrected %LAEF. Results: In comparison to control subjects, the study group had more diabetic and hypertensive patients, increased all LV dimensions, estimated LVEDP (p<0.0001), LAVI (p<0.0001), LAEF and %LAEF (p<0.0001). On comparing different grades of diastolic dysfunction, patients with worse grades of diastolic dysfunction were older, more hypertensive and diabetic. They had larger LV dimensions, estimated LVEDP (p<0.0001), and LAVI (p<0.0001). LAEF and %LAEF showed an increase from grade I (8.84 ± 3.09 Kdynes, 188.93 ± 40.12%) to Ia (10.66 ± 3.10 Kdynes, 239.7 ± 72.45%) to II (11.82 ± 45.9 Kdynes, 256.57 ± 45.92%) then demonstrated a significant reduction in grade III to 2.77 ± 1.71 Kdynes, 57.88 ± 32.49% (p<0.0001) dropping below normal values seen in the control subjects (4.98 ± 1.72 Kdynes, 93.30 ± 9.31%) (p<0.0001). Linear regression analysis showed factors affecting %LAEF were: age, E-wave velocity, average e’ velocity, E/A ratio and E/e’ ratio. Conclusions: LAEF is generally increased in patients with LV diastolic dysfunction compared to those with normal diastolic function. Patients in grade III diastolic dysfunction show marked impairment of LAEF dropping below those with normal diastolic function.

Atrial dominance in the human embryonic heart: a study of cardiac function at 6-10 weeks of gestation.

To investigate the difference in forces developed by atrial and ventricular myocardium during contraction in human embryos using a novel method. This was a cross-sectional study of 115 pregnancies examined at 6-10 weeks of gestation. Ventricular inflow and outflow velocities were obtained by Doppler echocardiography and the relative force development was evaluated by calculating the ratio between atrial and ventricular ejection force (EF). Data from 97 embryos with monophasic ventricular filling were analyzed. Both inflow and outflow cardiac velocities increased with advancing gestational age (P < 0.001). The mean peak inflow velocity (31.7 ± 10.2 cm/s) was significantly higher (P < 0.0001) than the outflow velocity (19.6 ± 6.1 cm/s). The EFinflow /EFoutflow ratio was more than 1.0 in all but four (96%) cases. Our study indicates the possibility of atrial dominance in the embryonic period of heart development, which may have clinical implications, as deviations from this normal pattern may indicate human embryonic cardiac dysfunction.

Atrial Functions and Aortic Elasticity in Children with Aortic Coarctation.

Coarctation of the aorta (CoA) is a chronic vascular disease characterized by a persistence of myocardial and vascular alterations. We aimed to evaluate children who have had successful coarctation surgery or balloon dilatation to evaluate the elasticity of the aorta, left atrial ejection force (AEF) and myocardial performance collectively at midterm follow-up. Nineteen patients (7.15 ± 0.9 years of age) and 21 age-sex matched healthy children were included in this study. Left AEF index is defined as the product of mass and acceleration of blood expelled from the left atrium. Aortic stiffness and distensibility were estimated using ascending and descending aorta diameters. The left atrial force index [(g∙cm/s(2))/m(2)] in the patient group was found to be significantly higher (12.69 ± 7.29, 5.74 ± 2.59, respectively, p = 0.001). Distensibility of the ascending aorta (cm(2)/dynes 10(-6)) was significantly lower in the patient group than in the control group (42.13 ± 24.02, 78.79 ± 20.49, respectively, p < 0.001). The stiffness index of the ascending aorta was significantly higher in the patient group (p < 0.001). We also documented that atrial force index is associated with peak E velocity, right arm systolic blood pressure and left ventricular mass index. Our investigation showed that AEF is higher in children who have had successful coarctation surgery or balloon dilatation, and AEF is associated with systolic blood pressure, peak E velocity and left ventricular mass index. Distensibility of the ascending aorta was lower, and stiffness index was higher in children with corrected CoA than in healthy subjects. Atrial ejection force; Balloon dilatation; CoA; Coarctation surgery; Distensibility; Stiffness index.

Atrial ejection force and brain natriuretic peptide as markers for mortality in sepsis

BackgroundIn early stages of septic shock, impaired myocardial function plays an important prognostic role. AEF and Plasma BNP level may be a valuable prognostic factor for patients with sepsis. ObjectiveWe aimed also to evaluate the value of atrial ejection force (AEF) B-type natriuretic peptide (BNP) in predicting the outcome of sepsis, severe sepsis and septic shock patients. Methods40 patients presenting with sepsis, severe sepsis or septic were included in the study. The patients had undergone transthoracic Echocardiographic examinations and BNP measurements on the 1st and 3rd day of admission. The patients were retrospectively divided into survivors and non survivors. ResultsThere was a significant statistical difference in BNP level (P=0.0001) between the two groups. BNP showed a statistically significant rise in the non survival group from day 1 to day 3 (p=0.002) and a statistically significant decrease from day 1 to day 3 in the survived group (p=0.001). As regards the echo findings there was a statistically significant difference AEF 3rd day between survivors and non survivors (P=0.0001). The ROC curve showed that BNP 1st day, 3rd day are good tests for prediction of mortality in patients with sepsis. ConclusionAtrial ejection force on the first day of admission, unlike BNP level, might not be used as an independent predictor of mortality in patients with sepsis. BNP level correlates with the severity of sepsis. According to our study, AEF in the third day may be a good predictor for survival of patients presenting with sepsis.

GW25-e0879 Left atrial ejection force is independent of left atrial volume in heart failure patients

GW25-e0879 Left atrial ejection force is independent of left atrial volume in heart failure patients

OP-328 Assessment of Left Atrial Ejection Force and Left Atrial Volume Index in Behcet Disease’s Patients

Evaluation of left atrial size and function using traditional and more recent echocardiographic parameters is potentially feasible in the routine clinical setting. Conventional echocardiographic parameters include the assessment of phasic atrial activity using atrial volume measurements, transmitral Doppler peak A velocity and the atrial ejection force (LAEF). The atrial ejection force has been proposed as a measure of atrial mechanical function and as an indicator of left ventricular diastolic properties.

The impact of atrial fibrillation paroxysms on left atrial function measured by strain imaging

Objective: To reveal the role of two-dimensional speckle tracking strain imaging (STSI) in study of the left atrial (LA) function changes in patients (pts) with paroxysmal atrial fibrillation (PAF), and assess the relationship between the frequency of symptomatic arrhythmic episodes and echocardiographic data. Methods: The effect of symptomatic arrhythmic episodes on LA was studied in 47 pts with lone PAF (age 44±8 years, 29 men). Pts were divided into two groups based on the frequency of the symptomatic AF paroxysms. The first group (n=25) included pts with paroxysms frequency of no more than one time in a three-month period. The pts of the second group (n=22) had more than one paroxysm during the same three-month period. AF paroxysms anamneses in all groups were between 1 to 10 months. As a reference standard the conventional measures of LA function were determined atrial emptying fraction and atrial ejection force. Peak strain (S) was measured at LA setpal and lateral segments during ventricular systole (LAs) and early diastole (LAe). Results: In the second group the strain from both the septal and lateral portion of the LA were significantly lower compared to the first group (S-LAs (%) 24.1±4.5 vs. 13.5±4.1, p<001; S-LAe (%) 8.0±2.5 vs. −0.5±2.1, p<001). Frequent AF paroxysms correlated significantly with LA ejection force (r=-0.57; p<0.005), atrial emptying fraction (r=-0.61; p<0.005) and S-LAs (r=-0.54; p<0.005). There were no significant differences in the other echocardiographic measurements or demographic variables. Conclusion: LA systolic strain, early diastolic strain by STSI significantly decreased in frequent AF paroxysms group. STSI of LA appears to be a promising tool in assessing LA function and filling pressure. LA ejection force, atrial emptying fraction and peak strain measured at LA setpal and lateral segments during ventricular systole could be used as an indicator of gradual mechanical remodeling of the atrium, which may favour recurrence and perpetuation of AF.

GW24-e0413 Pulmonary artery stiffness in patients with heart failure

ObjectivesThere is increasing recognition that pulmonary artery stiffness (PAS) is an important determinant of right ventricular afterload in pulmonary arterial hypertension. Pulmonary hypertension and right ventricular dysfunction are usually being...