Indexed Left Atrial Volume is a More Sensitive Indicator of Filling Pressures and Left Heart Function Than Is Anteroposterior Left Atrial Diameter

Moya-Mur, José-Luis; García-Martín, Ana; García‐Lledó, Alberto; Ruiz-Leria, Soledad; Jiménez-Nacher, José Julio; Megias-Sanz, Alicia; Taboada, Dolores; Muriel, Alfonso

doi:10.1111/j.1540-8175.2010.01216.x

Cited by 26 publications

(24 citation statements)

References 25 publications

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“…These findings could be explained by several reasons: First, the loss of the regular atria contraction during AF might lead to a severe volume overload in the LA and this might increase the LAP. The correlation between LAP and LAV has been reported earlier, our results confirm these findings [29,30]. …”

Section: Discussionsupporting

confidence: 93%

Measurement of Left Atrial Pressure is a Good Predictor of Freedom From Atrial Fibrillation

Bergau

Vollmann

Lüthje

et al. 2014

Indian Pacing and Electrophysiology Journal

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BackgroundIt is suggested that an elevated left atrial pressure (LAP) promotes ectopic beats emanating in the pulmonary veins (PVs) and that LAP might be a marker for structural remodeling. This study aimed to identify if the quantification of LAP correlates with structural changes of the LA and may therefore be associated with outcomes following pulmonary vein isolation (PVI).MethodsWe analysed data from 120 patients, referred to PVI due to drug-refractory atrial fibrillation (AF) (age 63±8; 57% men). The maximum (mLAP) and mean LAP (meLAP) were measured after transseptal puncture.Results and ConclusionsWithin a mean follow-up of 303±95 days, 60% of the patients maintained in sinus rhythm after the initial procedure and 78% after repeated PVI. Performing univariate Cox-regression analysis, type of AF, LA-volume (LAV), mLAP and the meLAP were significant predictors of recurrence after PVI (p=0.03; p=0.001; p=0.01). In multivariate analysis mLAP>18mmHg, LAV>100 ml and the presence of persistent AF were significant predictors (p=0.001; p=0.019; p=0.017). The mLAP >18 mmHg was associated with a hazard ratio of 3.8. Analyzing receiver-operator characteristics, the area under the curve for mLAP was 0.75 (p<0.01). mLAP >18 mmHg predicts recurrence with a sensitivity of 77 % and specificity of 60 %. There was a linear correlation between the LAV from MDCT and mLAP (p = 0.01, R2 = 0.61). The mLAP measured invasively displays a significant predictor for AF recurrence after PVI. There is a good correlation between LAP and LAV and both factors may be useful to quantify LA remodeling.

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Section: Discussionsupporting

confidence: 93%

Measurement of Left Atrial Pressure is a Good Predictor of Freedom From Atrial Fibrillation

Bergau

Vollmann

Lüthje

et al. 2014

Indian Pacing and Electrophysiology Journal

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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: 90%

“…17 Assessment of LV preload pressure typically requires cardiac catheterization; however, pulmonary vein dimensions have been shown to correlate with left atrial dimensions, 22,23 which, in turn, correlate with measures of LV fi lling pressure. 24,25 Therefore, we measured pulmonary vein dimensions using contrast-enhanced MRI in a study of patients with predominantly mild to moderate COPD and of control subjects. Reduced pulmonary vein cross-sectional area would favor a process resulting in reduced LV fi lling pressures, such as elevated pulmonary vascular resistance (PVR), whereas increased pulmonary vein area would favor a mechanism of intrinsic dysfunction of the LV.…”

Section: Copd Case Statusmentioning

confidence: 99%

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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“…LAVI is a strong indicator of LA and LV filling pressures [24,29]. In the general population, as well as in hemodialysis patients, LAVI is correlated with the severity of diastolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Galectin-3 als neuer Biomarker diastolischer Funktionsstörung bei Hämodialysepatienten

Gürel

Yılmaz

Çelik

et al. 2015

Herz

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Indexed Left Atrial Volume is a More Sensitive Indicator of Filling Pressures and Left Heart Function Than Is Anteroposterior Left Atrial Diameter

Abstract: Indexed atrial volume correlates better with LA pressure surrogates than the anteroposterior diameter, even when this is corrected for body surface.

Cited by 26 publications

References 25 publications

Measurement of Left Atrial Pressure is a Good Predictor of Freedom From Atrial Fibrillation

Measurement of Left Atrial Pressure is a Good Predictor of Freedom From Atrial Fibrillation

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

Galectin-3 als neuer Biomarker diastolischer Funktionsstörung bei Hämodialysepatienten

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