Atrial Function Index Research Articles

Right Atrial Function Index in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Thromboendarterectomy

Purpose Chronic thromboembolic pulmonary hypertension (CTEPH) can be effectively treated with pulmonary thromboendarterectomy (PTE). The standard for assessing postoperative success is through right heart catheterization measurements of mean pulmonary arterial pressure (mPAP) and peripheral vascular resistance (PVR). Recently, a novel echocardiographic parameter (right atrial function index, RAFi) was shown to predict clinical outcomes in patients (pts) with precapillary PH. In this study, we assessed the utility and predictive value of this novel index in CTEPH patients before and after PTE. Methods 50 consecutive CTEPH pts with pre- and post-PTE echocardiograms (echos) were studied. RA volumes were assessed in the apical 4 chamber view. RA end-systolic volume (ESV) was measured just before tricuspid valve opening; RA end diastolic volume (EDV) was assessed at tricuspid valve closure. RV outflow tract velocity time integral (VTI) was also obtained in all pts. Calculations RAEF = ([RAESV-RAEDV]/RAESV)*100RAESVi = RAESV(mL)/BSA(m2)RAFi = (RAEF (%)*VTI (cm))/RAESVi (mL/m2) Results The mean pre-op RAFi was 24.1 ± 23.5; mean post-op RAFi was 20.2 ± 17.7 (p=0.27). Before PTE, there was a modest correlation between RAFi & mPAP (R= -0.399, p Conclusion In our patient population, RAFi was surprisingly unchanged statistically (and trended downward) after successful PTE. This trend may be due to sudden changes in RAESV and RAEDV or postoperative RV stunning, which could have caused the minimal change in RVOT VTI. Thus, RAFi cannot be used as a noninvasive parameter of post-PTE success. However, there is a significant correlation between pre-op RAFi and traditional invasive measurements that may be useful in the noninvasive assessment of pts with CTEPH.

Haemodynamic determinants of improved aerobic capacity after tricuspid valve surgery in Ebstein anomaly

BackgroundAlthough tricuspid valve surgery improves functional capacity in patients with Ebstein anomaly, it is not always associated with improvement in aerobic capacity. The purpose of this study was to identify...

ATRIAL EMPTYING FRACTION PREDICTS MAINTENANCE OF SINUS RHYTHM POST DIRECT CURRENT CARDIOVERSION FOR ATRIAL FIBRILLATION

Atrial volumes indexed to body surface area (AVI) are robust predictors of non-valvular atrial fibrillation (AF) recurrence post direct current cardioversion (DCCV). The incremental value of atrial emptying fraction, an index of atrial function, compared to atrial volumes as a predictor for AF recurrence following DCCV has not been evaluated. We sought to compare the predictive ability of baseline left atrial emptying fraction (LA EMF), RA EMF, LAVI, and RAVI for post DCCV AF recurrence at 6 months. Pre-specified data was collected for patients enrolled in the AF Clinic Registry. The first 95 patients enrolled constituted the study cohort. Echocardiogram was performed within 6 months pre-cardioversion. Maximal LAVI, RAVI, LA EMF, and RA EMF were performed offline using 4 chamber single plane Simpson’s method, averaged over 5 cycles. ECG was performed at baseline, precardioversion, and at each clinic visit. Of the 95 patients who underwent DCCV 66 (70%) had reverted to AF prior to 6 months. Mean age was 63 years and 67% were male. A history of hypertension, diabetes mellitus, and heart failure was identified in 63%, 15%, and 28% of patients, respectively. The overall performance for prediction of AF recurrence at 6 months was greatest for RA EMF; area under the receiver operator characteristic curve (AUC): RA EMF 0.953, LA EMF 0.910, RAVI 0.766 and LAVI 0.639. For prediction of AF recurrence at 6 months, RA EMF of 41% was associated with 83% sensitivity and 100% specificity, with a positive predictive valve of 100% and a negative predictive value of 73%. Overall accuracy of RA EMF > 41% was 90.5% for prediction of AF recurrence. LA EMF had similar, but lower predictive value at a cut point of 43%, though all were superior to those for RAVI or LAVI. Atrial EMF AUCs were significantly higher than for LAVI or RAVI (max p = 0.01). While RAVI and LAVI are robust predictors of AF recurrence post DCCV, RA and LA EMF outperformed atrial volume in this cohort.

669 Right Atrial Emptying Fraction as an Index of Global Right Atrial Function: A Sensitive and Robust Marker of Right Ventricular Remodeling

669 Right Atrial Emptying Fraction as an Index of Global Right Atrial Function: A Sensitive and Robust Marker of Right Ventricular Remodeling

Ratio of Plasma ANP Level to BNP Level is an Index of Atrial Function in Patients with Sinus Rhythm

Ratio of Plasma ANP Level to BNP Level is an Index of Atrial Function in Patients with Sinus Rhythm

Ratio of Plasma ANP Level to BNP Level is an Index of Atrial Function in Patients with Sinus Rhythm

Ratio of Plasma ANP Level to BNP Level is an Index of Atrial Function in Patients with Sinus Rhythm

Atrial ejection force: A noninvasive assessment of atrial systolic function

Objectives. The purpose of this study was to define atrial ejection force and to develop a method for its noninvasive measurement from echocardiographic data.Background. Assessment of diastolic function through measurement of the components of ventricular filling has largely neglected the vigor of atrial systole, in part because this has been difficult to quantify. However, atrial ejection force, defined as that force exerted by the left atrium to accelerate blood into the left ventricle during atrial systole, can be assessed noninvasively by combined two-dimensional imaging and Doppler echocardiography. This index of atrial function, based on classic newtonian mechanics, provides a physiologic assessment of atrial systolic function.Methods. To evaluate the usefulness of atrial ejection force, we studied the return of left atrial ejection force in 29 patients after elective cardioversion for atrial fibrillation. Transmitral Doppler inflow patterns at rest were assessed immediately after cardioversion and at 24 h, 1 week, 1 month and >3 months later. A healthy adult group (n = 10) served as control subjects.Results. After successful cardioversion, atrial ejection force was significantly depressed compared with that in the control group (5.2 ± 6.8 vs. 16.3 ± 4,7 kdynes; p < 0.0001). Over successive weeks, atrial ejection force improved in the subgroup of patients who remained in sinus rhythm (n = 18), whereas no improvement was seen during the period of maintained sinus rhythm in the patients with subsequent reversion to atriai fibrillation (n = 11).Conclusions. Atrial ejection force provides a physiologic assessment of atrial systolic function and is a potentially useful index for assessing atrial contribution to diastolic performance. In patients who successfully underwent cardioversion from atrial fibrillation, atrial ejection force improved over several weeks only in the subgroup in which sinus rhythm was maintained.