LA Passive Emptying Fraction Research Articles

Interaction effect of type 2 diabetes mellitus and hypertension on left atrial function: a three-dimensional echocardiography study.

Type 2 diabetes mellitus (T2DM) and hypertension (HT) often coexist and contribute to left atrial (LA) functional abnormalities. The aim of the present study was to explore whether there is a potential interaction effect between T2DM and HT on LA function. A total of 135 patients (45 with T2DM only, 45 with HT only, and 45 with both T2DM and HT) were enrolled and compared to 45 age- and sex-matched controls. LA volume fraction, including LA ejection fraction (LAEF), LA expansion index (LAEI), LA passive emptying fraction (LAPEF), and LA active emptying fraction (LAAEF), and strain parameters, including LA reservoir longitudinal strain (LASr), LA conduit longitudinal strain (LAScd), and LA contraction longitudinal strain (LASct), were obtained using three-dimensional echocardiography (3DE). Patients with T2DM had significantly more impaired LA reservoir and conduit functions compared to those without T2DM (P<0.05), and patients with HT had a significantly more impaired LA reservoir function, conduit function, and booster pump function compared to those without HT (P<0.05). Two-way analysis of variance showed that there were significant additive interaction effects between T2DM and HT with respect to LASr (PT2DM + HT =0.002) and LAScd (PT2DM + HT =0.001). Generalized linear model demonstrated that T2DM + HT had a greater relative contribution than either T2DM or HT alone to the LA strain indexes, even after adjustment for other confounders (LASr, βT2DM + HT =-3.931, 95% CI: -6.237 to -1.624, P=0.001; LAScd, βT2DM + HT=-3.781, 95% CI: -5.653 to -1.908, P<0.001). Both T2DM and HT had an adverse effect on LA function. The coexistence of both conditions further impaired LA performance in an additive interaction fashion.

Changes of left atrial morphology and function evaluated with four-dimensional automated left atrial quantification echocardiography in patients with coronary slow flow phenomenon and preserved left ventricular ejection fraction

BackgroundCoronary slow flow phenomenon (CSFP) can cause left ventricular diastolic dysfunction (LVDD). In multiple studies, the left atrial (LA) strain has been reported to be an excellent parameter for assessing LVDD. The 4-dimensional automated LA quantification (4D Auto LAQ) dedicated to the LA was recently available. Our study aimed to evaluate subclinical changes in LA morphology and function with 4D Auto LAQ in patients with CSFP and preserved left ventricular ejection fraction (LVEF). MethodsForty-eight patients with CSFP confirmed with coronary angiography and 46 age and gender-matched controls with normal coronary flow were enrolled. The thrombolysis in myocardial infarction frame count (TFC) method was used to record coronary blood flow velocities for each major coronary artery. LA volume, LA longitudinal and circumferential strains during each of the three LA phases (reservoir, conduit, and contraction), LA total emptying fraction (LATEF), LA active emptying fraction (LAAEF), and LA passive emptying fraction (LAPEF) were quantified with 4D Auto LAQ analysis. ResultsCompared with controls, LA longitudinal reservoir strain (LASr), LA longitudinal strain during the conduit phase (LAScd), LA contraction strain (LASct), LA conduit circumferential strain (LAScd-c), LATEF, LAPEF decreased significantly in individuals with CSFP. Of the 4D- LAQ parameters, only LASr [odds ratio (OR): 0.773, P < 0.001] and LATEF [OR: 0.762, P < 0.001] were associated with CSFP in multivariate analysis. A LASr ≤23.00% can differentiate CSFP from controls [sensitivity, 66.7%; specificity, 93.5%; area under the curve (AUC), 0.823; P < 0.001]. A LASr of ≤19.00% could predict the elevation of LV filling pressure in the CSFP cohort [sensitivity, 76.9%; specificity, 74.3%; area under the curve (AUC), 0.792; P < 0.001]. LASr was the only index to demonstrate significant changes compared to controls in single-vessel CSFP. Compared to the right coronary artery (RCA) and left circumflex (LCX), TFC of the left anterior descending (LAD) artery was the only independent variable of LASr (Standardized Coefficients: -0.386, P = 0.037). ConclusionsImpairment of LA reservoir function reflected by changes in LASr and LATEF can be seen in patients with CSFP. LASr could predict the elevation of LV filling pressure in CSFP individuals. LASr is more sensitive than LATEF in detecting LA reservoir dysfunction in single-vessel CSFP. CSFP in LAD exerts a more prominent influence on LASr than RCA or LCX.

Assessment of left atrial volume and function in patients with Sjögren's syndrome using three-dimensional echocardiography.

We used real time, three-dimensional transthoracic echocardiography (3DTTE) to evaluate left atrial (LA) volume and mechanical function in patients with primary Sjögren's syndrome (SS). We prospectively included 42 consecutive patients with primary SS and 42 controls who were similar in terms of basal characteristics. 3DTTE was used to assess LA function. Maximum LA volume, minimum LA volume, pre-atrial contraction LA volume, LA Active Stroke Volume (ASV), LA Total Stroke Volume (TSV), maximal left atrial volume index (LAVImax), Left atrial pre-contraction volume index, and Left atrial minimum volume index, ASV index, and TSV index were significantly higher in the SS group, and the LA Total Emptying Fraction, LA Expansion Index, and LA Passive Emptying Fraction were significantly lower. Although the active emptying fraction was higher in the SS group, the difference was not statistically significant. LAVImax was positive correlated with disease duration (r=.753). Left atrial function is impaired in SS patients and serves as an early marker of subclinical cardiac involvement.

Evaluation of left atrial function in patients with severe preeclampsia by full-volume imaging technology

Objective To evaluate the left atrial(LA) function in patients with severe preeclampsia(SPE) by full-volume imaging technology. Methods Forty-two patients of SPE were randomly chosen as SPE group, 34 healthy pregnant women were selected as the control group. LA related function parameters including LA maximum volume(LAVmax), LA minimum volume(LAVmin), LA pre-atrium contraction volume(LAVpre), LA reservoir volume(LARV), LA passive emptying volume(LAPEV), LA contraction volume(LACV), LA expansion index(LAEI), LA passive emptying fraction(LAPEF), LA passive emptying fraction(LAAEF) were separately required by biplane area-length method and full-volume imaging technology in antepartum and postpartum. Results Compared with control group before delivery, the parameters of SPE group before delivery such as LAVmax, LAVmin, LAVpre were higher, LAEI, LAPEF, LAAEF indexed to body surface area(BSA) were lower(all P 0.05). Compared with SPE group before delivery, the parameters of SPE group after delivery such as LAVmax, LAVmin, LAVpre were lower, LAEI, LAPEF, LAAEF indexed to BSA were higher(all P 0.05). Conclusions Full-volume imaging technology can quantitatively evaluate the LA function. LA reservoir function, conduit function and booster pump function are reduced in SPE before delivery, LA rereservoir function, conduit function and booster pump function are basically recovery in SPE after delivery. Key words: Echocardiography; Pre-eclampsia; Atrial function, left; Full-volume imaging technology

Acute Impact of Balloon Mitral Valvotomy on Left Atrial Functions in Mitral Stenosis

Background: Rheumatic mitral stenosis (MS) is associated with progressive impairment of left atrial (LA) mechanical functions. This study was conducted to assess the acute impact of Balloon Mitral Valvotomy (BMV) on these functions. Methods: This single centre observational study included 25 patients with severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area of 0.74 ± 0.13 cm²), in sinus rhythm, who underwent successful BMV at our hospital. Phasic LA volumes (Vmax: maximal LA volume, Vmin: minimal LA volume, and Vp: LA volume at the onset of P-wave) were measured by modified Simpson’s method. Parameters of LA reservoir function i.e. LA total emptying fraction (LATEF) and LA expansion index (LAEI); conduit function i.e. LA passive emptying fraction (LAPEF); and pump function i.e. LA active emptying fraction (LAAEF) were calculated from these volumes. All these parameters were evaluated before and 24-48 hours after BMV. Results: Successful BMV led to significant reduction in Vmax (p < 0.001), Vmin (p < 0.001), and Vp (p < 0.001). There was a significant increase in LATEF (p= 0.001) and LAEI (p= 0.002). LAPEF increased insignificantly (p= 0.057), while there was no significant change in LAAEF (p =0.127) after BMV. Conclusion: Successful BMV leads to early improvement in left atrial reservoir and conduit functions, without significantly affecting left atrial pump function. Whether these acute changes translate into long term left atrial reverse remodelling and clinical benefits thereof needs to be established by further studies.

The influence of white-coat hypertension on left atrial phasic function

We aimed to investigate the association between white-coat hypertension (WCH) and left atrial (LA) phasic function assessed by the volumetric and speckle tracking method. This cross-sectional study included 52 normotensive individuals, 49 subjects with WCH and 56 untreated hypertensive patients who underwent a 24-h ambulatory BP monitoring and complete two-dimensional echocardiographic examination (2DE). WCH was diagnosed if clinic blood pressure (BP) was elevated and 24-h BP was normal. We obtained that maximum, minimum LA and pre-A LAV volumes and volume indexes gradually and significantly increased from the normotensive subjects, throughout the white-coat hypertensive individuals to the hypertensive patients. Passive LA emptying fraction (EF), representing the LA conduit function, gradually reduced from normotensive to hypertensive subjects. Active LA EF and the parameter of the LA booster pump function increased in the same direction. Similar results were obtained by 2DE strain analysis. The LA stiffness index gradually increased from normotensive controls, throughout white-coat hypertensive subjects to hypertensive patients. Clinic systolic BP was associated with LA passive EF (β= −0.283, p = 0.001), LA active EF (β = 0.342, p < 0.001), LA total longitudinal strain (β= −0.356, p < 0.001), LA positive longitudinal strain (β= −0.264, p = 0.009) and LA stiffness index (β = 0.398, p < 0.001) without regard to age, BMI, left ventricular structure and diastolic function in the whole study population. In the conclusion, WCH significantly impacts LA phasic function and stiffness. Clinic systolic BP was associated with functional and mechanical LA remodeling in the whole study population.

Predictors of Future Atrial Fibrillation Development in Patients with Hypertrophic Cardiomyopathy: A Prospective Follow‐Up Study

We evaluated whether left atrial (LA) phasic functions, P-wave dispersion (PWD), and plasma NT-proBNP levels could predict future development of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). Seventy patients with HCM were evaluated. The LA phasic functions including the LA total emptying volume (LATEV), LA total emptying fraction (LATEF), LA active emptying volume (LAAEV), LA active emptying fraction (LAAEF), LA passive emptying volume (LAPEV), and LA passive emptying fraction (LAPEF) were evaluated. P-wave dispersion was calculated. Plasma NT-proBNP levels were measured on the same day with echocardiographic study. Patients were followed up 53.09 ± 1.87 months. Patients who developed AF (n = 18) had significantly higher PWD values, NT-proBNP levels, LAVI, E/E' av, and resting LVOT gradients and significantly lower LATEF and LAAEF. In multivariate analysis, LATEF (P = 0.002), LAAEF (P = 0.007), logNT-proBNP level (P = 0.022), and PWD (P = 0.018) were associated with AF development. The results of receiver operating characteristic analysis revealed that a LATEF cutoff value 49% with 72% sensitivity and 81% specificity, a LAAEF cutoff value of 36% with 72% sensitivity and 71% specificity, and an NT-proBNP cutoff value of 720 pg/mL predicted future AF development with 72% sensitivity and 60% specificity. A PWD cutoff value of 47.5 msecond predicted future AF development with 78% sensitivity and 72% specificity. In patients with HCM, LA phasic functions, PWD, and NT-proBNP levels predict future development of AF. Assessment of LA phasic functions during routine echocardiographic evaluation and measuring NT-proBNP levels and PWD values of patients with HCM during daily practice may provide important data in predicting those at high risk of AF occurrence.

13. Immediate Effect of percutaneous transvenous mitral commissurotomy on atrial electromechanical delay and left atrial mechanical functions in patients with rheumatic mitral stenosis

Rheumatic mitral stenosis (MS) is associated with prolonged inter and intra-atrial electromechanical delays and impaired left atrial (LA) mechanical functions, which are considered to be markers of atrial fibrillation (AF) risk. This study was conducted to assess the immediate effect of successful percutaneous transvenous mitral commissurotomy (PTMC) on these parameters. This observational study included 25 patients with symptomatic, severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area (MVA) of 0.74 ± 0.13 cm2), in normal sinus rhythm, who underwent successful PTMC at our hospital. Inter-atrial (AEMD), left intra-atrial (L-IAEMD) and right intra-atrial (R-IAEMD) electromechanical delays were measured on tissue Doppler imaging. Phasic LA volumes (Vmax: maximal LA volume, Vmin: minimal LA volume and Vp: LA volume at P-wave onset) were measured by modified Simpson’s method. Parameters of LA reservoir function i.e. LA total emptying fraction (LATEF) and LA expansion index (LAEI); conduit function i.e. LA passive emptying fraction (LAPEF); and pump function i.e. LA active emptying fraction (LAAEF) were calculated from the phasic LA volumes. PTMC was performed using the standard Inoue Balloon technique. All these parameters were evaluated and compared before and 24–48 h after PTMC. Successful PTMC led to significant reduction in AEMD (p < 0.001), L-IAEMD (p < 0.001), R-IAEMD (p < 0.001), Vmax (p < 0.001), Vmin (p < 0.001) and Vp (p < 0.001). There were significant increments in LATEF (p = 0.001), LAEI (p = 0.002) and LAPEF (p = 0.05), while there was no significant change in LAAEF (p = 0.127) after PTMC. Successful PTMC has a favorable early impact on left atrial mechanical functions and other novel parameters of atrial electromechanical remodeling in MS patients. Large scale prospective studies are required to confirm whether improvement in these markers translates into reduced long term AF risk in these patients.

Early- and mid-term effects of percutaneous mitral balloon valvuloplasty on left atrial mechanical functions in mitral stenosis.

The aim of the study was to evaluate left atrial (LA) mechanical functions in MS before and after percutaneous mitral balloon valvuloplasty (PMBV) and to follow it up in short- and mid-term. We carried out a prospective study of 49 patients with critical mitral stenosis (MS) who had normal sinus rhythm. LA mechanical functions were evaluated before and 24-48 h, 3 months, and 1 year after PMBV, which included LA passive emptying volume (LAPEV), LA active emptying volume (LAAEV), LA total emptying volume (LATEV), LA passive emptying fraction (LAPEF), LA active emptying fraction (LAAEF), LA total emptying fraction (LATEF), and conduit volume. The transthoracic echocardiography parameters of the MS patients before and 24-48 h, 3 months, and 1 year after PMBV were as follows: (a) mitral valve area 1.1 cm² (0.9-1.6); 2.2 cm² (1.8-2.8) (p<0.001); 2.2 cm² (1.7-2.9) (NS); 2.1 cm² (1.8-2.7) (p<0.001); (b) LAPEV 13 ml/m² (9-27); 11 ml/m² (8-19) (p<0.001); 10 ml/m² (7-19) (p<0.001); 10 ml/m² (6-18) (p<0.001); (c) LATEV 26 ml/m² (19-50); 21 ml/m² (16-40) (p<0.001); 20 ml/m² (15-36) (p<0.001); 19 ml/m² (15-34) (p<0.001); (d) Conduit volume 30 ml/m² (22-44); 33 ml/m² (26-46) (p<0.001); 34 ml/m² (30-42) (p<0.001); 36 ml/m² (31-42) (p<0.001), respectively. However, LAAEV, LAPEF, LAAEF, and LATEF were not altered after PMBV. The findings of this study demonstrated an improvement of LA mechanical functions, which continued to improve for 1 year, after successful treatment of MS by PMBV.

Feasibility of Two‐Dimensional Global Longitudinal Strain and Strain Rate Imaging for the Assessment of Left Atrial Function: A Study in Subjects with a Low Probability of Cardiovascular Disease and Normal Exercise Capacity

Two-dimensional (2D) speckle imaging has shown that it could evaluate not only regional but also global strain (epsilon) and strain rate (SR) of the left and right ventricles. There are no data for global epsilon/SR imaging for left atrial (LA) function evaluation. A total of 54 subjects (37 men; mean age, 44 +/- 10 years) with normal treadmill exercise stress echocardiography and no coronary risk factors were enrolled. Global longitudinal LA epsilon/SR data obtained by 2D speckle imaging with automated software (EchoPAC, GE Medical) were compared with LA volumetric parameters. LA epsilon/SR imaging was acceptable in all patients. Bland-Altman analysis for these parameters showed no evidence of any systematic difference regarding inter- and intraobserver variabilities. Global longitudinal LA strain during systole and peak systolic global longitudinal LA SR were correlated with LA total emptying fraction (EF) (r = 0.399, P = 0.004; r = 0.366, P = 0.008). Global longitudinal LA strain during early diastole and peak early diastolic global longitudinal LA SR were correlated significantly with LA passive EF (r = 0.476, P < 0.001; r = 0.507, P < 0.001). Global longitudinal LA strain during late diastole and peak late diastolic global longitudinal LA SR were not correlated with LA active EF (r = 0.198, P = 0.163; r = 0.265, P = 0.060). Global longitudinal LA epsilon/SR parameters determined by 2D speckle tracking echocardiography are feasible and reproducible indices for the evaluation of LA function.

Evaluation of the changesof left atrial function in patients with hypertension by left atrial volume trackingmethod

：Objective To probe intothe clinical value of left atrial(LA) volme tracking method (LAVT) on the assessment ofleft atrial function in patients with hypertension. Methods Thirty-one patients withhypertension and 31 control subjects were involved. Images of apical two-chamber andfour-chamber views were obtained by two-dimensional echocardiography. LA maximal volume(LAVmax), LA minimal volume (LAVmin), LA presystolic volume (LAVpre), systolic LA fillingrate (dv/dtS), early diastolic LA emptying rate (dv/dtE) and late diastolic LA emptyingrate (dv/dtA) were derived using LAVT. LA passive emptying volume(LAVp), LA passiveemptying fraction(LAVpEF), LA active emptying volume(LAVa), LA active emptying fraction(LAVaEF), LA total emptying volume (LAVt), LA total emptying fraction(LAVtEF) werecalculated. All volume measurements were corrected to body surface area (LAVI). ResultsThere were significant differences in the LAVImax, LAVImin, LAVIpre, LAVpEF, LAVIa,LAVIt,dv/dtS, dv/dtA between hypertensive patients and control subjects(P <0.05~0.001),but no significant differences were found in the LAVp, LAVaEF, LAVtEF,dv/dtE between thetwo groups. The LAVImax has shown significant positive correlation with LAVIp, LAVIa andLAVIt(r = 0.588~0.812, P <0.001). LAVaEF has shown positive correlation with theLAVtEF(r = 0.833, P<0.001), whereas LAVpEF has not(r = 0.420, P <0.01). There was asignificant positive correlation with LAVImax and LAVIpre(r = 0.908, P <0.001), LAVIpreand LAVIa(r = 0.689, P <0.001) ,dv/dtE and LAVIp(r = 0.690, P <0.001),dv/dtA andLAVIa(r = 0.600, P <0.001). Conclusions In hypertensive patients,left atrial reservoirfunction and booster pump function increase, while left atrial conduit function decreases.LAVT has a potential ability to evaluate left atrial function.

Effects of dipper and non-dipper status of essential hypertension on left atrial mechanical functions

Aim: This study was designed in order to investigate the effects of dipper and non-dipper status of hypertension on left atrial mechanical (reservoir, conduit and booster pump) functions with left atrial volume measurements by means of two-dimensional echocardiography in untreated systemic hypertensive patients. Method: A total of 27 untreated dipper hypertensive patients, group I (15 female, 12 male, mean age 57±12 years); 23 untreated non-dipper hypertensive patients, group II (12 female, 11 male, mean age: 53±18 years); and 25 voluntary healthy individuals, group III (13 female, 12 male, mean age 53±10 years) were included into the study. Twenty-four hour blood pressure (BP) measurement was performed by the cuff-oscillometric method to evaluate the nocturnal decrease of BP. The patients whose night time mean blood pressure measurements were found 10% or more lower compared to mean day time measurements were classified as dipper hypertensive patients and the ones with a decrease of less than 10% were classified as non-dipper hypertensive patients. Left atrial (LA) volumes were measured echocardiographically according to biplane area-length method in apical four-chamber and two-chamber views. LA maximal volume ( V max) was recorded at the onset of mitral opening, LA minimal volume ( V min) was recorded at the onset of mitral closure and LA presystolic volume ( V p) was recorded at the beginning of the atrial systole (p wave on ECG). All volume measurements were corrected to body surface area, and following LA emptying functions parameters were calculated: LA passive emptying volume (LAPEV)= V max− V p, LA passive emptying fraction (LAPEF)=LAPEV/ V max, Conduit volume (CV)=left ventricular output volume-( V max− V min), LA active emptying volume (LAAEV)= V p− V min, LA active emptying fraction (LAAEF)=LAAEV/ V p, LA total emptying volume (LATEV)= V max− V min, LA total emptying fraction (LATEF)=LATEV/ V max. Results: LA volume indexes, V max, V min, and V p, were significantly increased in the hypertensive subgroups (groups I and II) than in controls ( p<0.001, p<0.001, p<0.001, respectively), but no significant difference was found in the V p values between group I and group II. V max and V min were larger in non-dipper hypertensive group than in dipper hypertensive group ( p<0.05 and p<0.05, respectively). LAPEV and LAPEF were observed to be significantly reduced in both dipper and non-dipper hypertensives than in control ( p<0.001 and p<0.05, respectively), and this difference was more obvious in non-dipper than dipper cases ( p<0.001). Conduit volume was significantly lower in hypertensive groups than controls ( p<0.05). LA active emptying volume ( p<0.001) and LAA active emptying fraction ( p<0.001) were significantly greater in hypertensive cases than in controls. Furthermore, LA active emptying volume in non-dipper hypertensive subjects was significantly greater than dipper hypertensive cases ( p<0.05). Left atrial total emptying volume and left atrial total emptying fraction in both hypertensive groups were similar to control ( p>0.05). Conclusions: Atrial reservoir and booster pump functions increase in hypertensive patients, but this result is more prominent in non-dipper hypertensives than in dipper hypertensive patients.