A Real-Time Three-Dimensional Echocardiographic Quantitative Analysis of Left Atrial Function in Left Ventricular Diastolic Dysfunction

Murata, Mitsushige; Iwanaga, Shiro; Tamura, Yuichi; Kondo, Masayuki; Kouyama, Keisuke; Murata, Mitsuru; Ogawa, Satoshi

doi:10.1016/j.amjcard.2008.05.067

Cited by 66 publications

(67 citation statements)

References 11 publications

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“…We think this explanation unlikely, however, given that the left atrium is typically enlarged in diastolic dysfunction with high, LV end-diastolic pressure. 25,[46][47][48] RV dilation with impingement on the LV is also an important consideration in states of very high pulmonary artery pressure, 15 which is unlikely in the present study of predominantly mild to moderate COPD. Smaller pulmonary vein dimensions were associated with reduced RV EDV.…”

Section: Discussionmentioning

confidence: 87%

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Smith

Prince

Hoffman

et al. 2013

Chest

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1143C hronic lower respiratory disease is the third-leading cause of death in the United States. 1 The most morbid components of chronic lower respiratory dis ease are COPD, defi ned by spirometry as airfl ow obstruction that is not fully reversible, and pulmonary emphysema, defi ned by morphology as permanent enlargement of airspaces accompanied by destruction of their walls. 2,3 Emphysema on CT imaging is present in approximately one-half of patients with COPD, 4-7 and an estimated 2% of the general population aged . 50 years has emphysema without spirometry-defi ned COPD. 8 The number of Americans with a diagnosis of heart failure was 5.7 million in 2008, and approximately one-half of prevalent heart failure cases are characterized by preserved ejection fraction. 9,10 By comparison, 12 million Americans have a diagnosis of COPD and an additional 12 million may have undiagnosed COPD and emphysema. 11Background: COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) fi lling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload. Methods: The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defi ned by spirometry. Percent emphysema was defi ned as regions , 2 910 Hounsfi eld units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking. Results: Among 165 participants, the mean ( Ϯ SD) total pulmonary vein area was 558 Ϯ 159 mm 2 in patients with COPD and 623 Ϯ 145 mm 2 in control subjects. Total pulmonary vein area was smaller in patients with COPD ( 2 57 mm 2 ; 95% CI, 2 106 to 2 7 mm 2 ; P 5 .03) and inversely associated with percent emphysema ( P , .001) in fully adjusted models. Signifi cant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defi ned COPD. Conclusions: Pulmonary vein dimensions were reduced in COPD and emphysema. These fi ndings support a mechanism of upstream pulmonary causes of underfi lling of the LV in COPD and in patients with emphysema on CT scan. CHEST 2013; 144(4):1143-1151Abbreviations: E/A ratio 5 ratio of peak fi lling rates during early phase diastole and atrial contraction; E/A ratioMR 5 ratio of peak fi lling rates during early phase diastole and atrial contraction estimated by magnetic resonance; EDV 5 end-diastolic volume; LV 5 left ventricle; MESA 5 Multi-Ethnic Study of Atherosclero...

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Section: Discussionmentioning

confidence: 87%

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Smith

Prince

Hoffman

et al. 2013

Chest

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“…10,11,20) Murata, et al found that patients who underwent a successful catheter ablation compared to those with recurrent AF revealed a reduced LA volume and improved LA reservoir and booster pump function, assessed by an LA volume change by 3D-STI. 14) Though these studies reported a deterioration in LA function, they used different parameters or assessed parameters in a different cardiac phase. Differences among these studies might be explained by various patient types and clinical stages of AF.…”

Section: Discussionmentioning

confidence: 99%

“…13) 3D-STI has been used to assess LA function. [14][15][16] Considering that functional changes of the LA in hypertensive heart could lead to paroxysmal AF (PAF), we investigated the influence of AF upon LA function or LA wall mechanical performance in hypertensive patients.…”

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confidence: 99%

Three-Dimensional Speckle Tracking Imaging for Assessing Left Atrial Function in Hypertensive Patients With Paroxysmal Atrial Fibrillation

et al. 2016

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SummaryHypertension (HT) is known to be the most prevalent risk factor for paroxysmal atrial fibrillation (PAF), however, its mechanisms have not been fully clarified. Our aim was to investigate the differences in left atrial (LA) function between healthy subjects, and hypertensive patients without PAF (HT-PAF(-)) and with PAF (HT-PAF(+)) using 3-dimensional (3D) speckle tracking imaging (STI). A total of 144 subjects were enrolled: 44 HT-PAF(+) (27 males; mean age 69 ± 10 years), 50 HT-PAF(-) (31 males; mean age 63 ± 11 years), and 50 controls (31 males; mean age 51 ± 14 years). All subjects were in sinus rhythm during the examination. LA volume, LA emptying fraction (LAEF), and LA wall strain were analyzed by 3D area tracking imaging. The maximal value of the global strain curve was defined as the peak global strain. The standard deviation of the time from the R-wave on the electrocardiogram to peak positive values of the segmental strain curves corrected by the R-R' interval in 6 mid LA segments (TP-SD) was calculated to assess LA dyssynchrony. LAEF and peak global strain were lower in HT-PAF(+) than in HT-PAF(-) (P < 0.01) and in the control (P < 0.01). Moreover, TP-SD was higher in HT-PAF(+) than in HT-PAF(-) (P < 0.05) and in the control (P < 0.01). Multivariate analysis revealed LA volume index, peak global strain, and TP-SD were independent determinants of HT-PAF(+). The presence of PAF is associated with diminished LA compliance and advanced mechanical dyssynchrony, as well as LA geometric deformation. (Int Heart J 2016; 57: 705-711) Key words: Three-dimensional echocardiography, Strain, Hypertension, Left atrium A trial fibrillation (AF) is the most common arrhythmia, and its frequency is increasing with the aging of populations. 1,2) Alterations in left atrial (LA) geometry and function, known as LA remodeling, often develop in AF. It is widely known that hypertension (HT) is a risk factor for developing AF and is often synergistically associated with it. Some large animal model studies have provided insights into atrial histological remodeling in HT.3,4) An enlargement of LA is a common finding in patients with HT, indicating hypertensive heart disease. 5,6) Furthermore, many studies have reported that LA enlargement is strongly associated with the incidence of cardiovascular outcomes including the incidence of AF, heart failure, or stroke. 7-9) A better understanding of atrial structure and function in patients with HT is crucial for predicting risk factors for and incidence of AF, as well as complications accompanying the disease.Speckle tracking imaging (STI) is a non-Doppler-based method for the objective quantification of regional myocardial function, independent of ultrasound beam direction. The feasibility of two-dimensional (2D-) STI for measuring LA deformation in patients with paroxysmal or persistent AF has been documented. [10][11][12] Three-dimensional (3D-) STI is thought to be preferable to 2D-STI because the ability of 3D-STI to track echo patterns in 3D-space would eliminate the prob...

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“…A ecocardiografia tridimensional em tempo real (E3DTR) é uma modalidade de imagem mais recente, não invasiva, que permite medir diretamente os volumes do AE ao longo de todo o ciclo cardíaco, sem a necessidade de modelos geométricos, com excelente resolução temporal 37 . Permite avaliar, com alta acurácia, o volume e a função do AE, e já foi estudada, com essa finalidade, em diversas situações clínicas [38][39][40] .…”

Section: Avaliação Volumétrica Do Aeunclassified

“…Algumas evidências de alterações da função atrial esquerda ou da sua rigidez em pacientes com insuficiência cardíaca representam um alento nesse tipo de avaliação 38,39,50,51 . Nesse cenário, por meio da ecocardiografia bidimensional, demonstrou-se que a capacidade física dos pacientes com miocardiopatia dilatada idiopática está diretamente relacionada à fração de esvaziamento do AE 52 .…”

Section: Na Insuficiência Cardíacaunclassified

Echocardiographic Evaluation of Left Atrial Function: Physiological and Clinical Aspects

Matsumoto¹,

Mancuso²,

Tatani³

et al. 2014

Arquivos Brasileiros De Cardiologia - Imagem Cardiovascular

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ResumoA avaliação da função atrial esquerda pode proporcionar informações importantes relacionadas à fisiopatologia de muitas cardiopatias, principalmente quando o envolvimento é das cavidades esquerdas. Entretanto, ao contrário das funções sistólica e diastólica do ventrículo esquerdo, amplamente exploradas em muitas condições clínicas, a função do átrio esquerdo é, ainda, pouco estudada.Conceitos básicos das funções de reservatório, de conduto e de bomba do átrio esquerdo são discutidos, destacando as relações com enchimento ventricular. Métodos de investigação dessas funções são apresentados de forma resumida. IntroduçãoAo contrário das funções sistólica e diastólica do Ventrículo Esquerdo (VE), amplamente analisadas em várias condições clínicas e experimentais, a função do Átrio Esquerdo (AE) tem sido pouco estudada, apesar de sua reconhecida importância no desempenho global do VE 1 .A análise da função atrial esquerda, associada ao estudo da diástole ventricular esquerda, pode acrescentar informações fundamentais para a compreensão dos mecanismos fisiológicos e fisiopatológicos envolvidos em diversas condições cardiovasculares.Com a abertura da valva mitral, AE e VE atuam praticamente como uma cavidade única e, portanto, com influência mútua no enchimento e esvaziamento dessas cavidades 2 .Vários fatores contribuíram para o ressurgimento do interesse no estudo da função atrial esquerda. Destacam-se: 1) ampla utilização de procedimentos envolvendo diretamente o AE, tais como intervenções medicamentosas, dispositivos eletrônicos, radioablação e cirurgias utilizadas no tratamento da fibrilação atrial [3][4][5] ; 2) reconhecimento de remodelamento elétrico, iônico e mecânico do AE 5 ; 3) fenômeno do "stunning" pós-cardioversão 6,7 ; e 4) importância prognóstica do tamanho e função atrial esquerda na insuficiência cardíaca [8][9][10] . Com a ecocardiografia, muitas informações das dimensões e da função atrial podem ser obtidas, utilizando técnicas e métodos mais recentemente validados, de forma simples e consistente 11 . Esta revisão tem como objetivo a abordagem de aspectos importantes da fisiologia do AE, que poderão auxiliar na interpretação de mecanismos en-volvidos na diástole do VE, em condições normais e de doenças. FisiologiaUma das funções do AE é proporcionar aporte sanguíneo para a diástole ventricular.Nesse processo estão envolvidos o relaxamento, a complacência e outras características funcionais do AE, e também as funções sistólica e diastólica do VE. Essas particularidades devem ser analisadas de forma integrada, pois são interdependentes e, portanto, indissociáveis. Entretanto, para fins didáticos, os conceitos serão comentados de forma separada.O AE exerce ação reguladora no enchimento ventricular por meio de três funções básicas: 1) de reservatório, durante a diástole atrial; 2) de conduto, durante o esvaziamento passivo no período de relaxamento ventricular e diástase; 3) de bomba propulsora na fase de contração, ou esvaziamento ativo, desde que em ritmo sinusal, o que contribui de forma signi...

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A Real-Time Three-Dimensional Echocardiographic Quantitative Analysis of Left Atrial Function in Left Ventricular Diastolic Dysfunction

Cited by 66 publications

References 11 publications

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Three-Dimensional Speckle Tracking Imaging for Assessing Left Atrial Function in Hypertensive Patients With Paroxysmal Atrial Fibrillation

Echocardiographic Evaluation of Left Atrial Function: Physiological and Clinical Aspects

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