Left atrial expansion index is an independent predictor of diastolic dysfunction in patients with preserved left ventricular systolic function: a three dimensional echocardiography study

Abstract

In the absence of mitral valve disease left atrial (LA) volume is a marker of diastolic dysfunction and its severity. This study investigated the relationship between left ventricular (LV) end diastolic pressure (LVEDP) and LA volumes and phasic atrial functions detected by real-time full volume three-dimensional echocardiography (RT3DE), in a patient population with preserved LV systolic function. Seventy-two (39 female and 33 male; mean age 56.1 ± 9.0 years) stable patients with normal LV ejection fraction (EF) undergoing cardiac catheterization were studied. All patients underwent comprehensive echocardiographic examination just before catheterization and LVEDP was obtained. In addition to conventional echocardiographic measurements and Doppler indices; by using RT3DE LA maximum, minimum and pre-a-wave volumes were measured; LA total, passive and active emptying volumes and fractions were calculated. LV systolic function was assessed by EF and global longitudinal strain by speckle tracking. RT3DE minimum LA volume index, RT3DE active LAEF and LA expansion index (EI) were statistically significant univariate predictors of LVEDP ≥ 16 mmHg. When age and hypertension adjusted multivariate analysis was performed EI [β = -1.741, p = 0.015; OR 0.175; 95 % CI (0.043-0.717)] was an independent predictor of elevated LVEDP. RT3DE evaluation of LA function during entire cardiac cycle has incremental value for the diagnosis of diastolic dysfunction in patients with preserved EF. We suggest that RT3DE evaluation of LA may find clinical application in this field.

Right Atrial Evaluation in Patients With Pulmonary Hypertension

“…The eligibility criteria were as follows: (1) a tricuspid regurgitation velocity of 2.8 m/s or higher and pulmonary artery (PA) systolic pressure of 35 mm Hg or higher, as measured on echocardiography; and (2) an established diagnosis of pulmonary hypertension (mean PA pressure >25 mm Hg in a catheter study). 20,21,23 The exclusion criteria were as follows: (1) cardiomyopathy, valvular disease, congenital heart disease, or systemic disease that might affect cardiac morphologic characteristics and function; (2) an unstable pH condition requiring treatment modification; (3) arrhythmias, including fibrillation and flutter; and (4) moderate or severe tricuspid regurgitation. All patients were referred from cardiovascular, respiration, rheumatology, and immunology clinics and were taking their prescribed daily drugs.…”

“…14,17 Real-time 3DE has been used extensively for assessment of ventricular volume and function, which has recently also been validated for left atrium (LA) determination. [18][19][20][21][22] However, limited data are available on the use of real-time 3DE for RA evaluation.…”

Sex differences in the agreement between left ventricular ejection fraction measured by myocardial perfusion scintigraphy and by echocardiography

“…These sex differences may also explain the observation of sex differences in LVEF as prognostic indicators of myocardial infarction and cardiac death. 17 There are a number of published papers assessing relationships between LVEF measured by MPS and Echo using a linear regression technique to provide correlation coefficients, 8,9,11,12,22 However, only a few of these studies assessed agreement between methods using Bland-Altman technique. 8,12 Scatter plots of LVEF measured by MPS or by Echo in our study confirm the deficiency of a correlation approach; the linear regression line deviated from origin indicating the presence of a bias.…”

Left Atrial Volumes and Phasic Function in Healthy Children: Reference Values Using Real-Time Three-Dimensional Echocardiography

“…Studies in adults show that LA size and function can serve as a marker for diastolic dysfunction. [1][2][3][4][5][6] In children, only few and small studies exist. Taggart et al 7 and Sakata et al 8 showed that situations with a left-to-right-shunt leading to a left ventricular (LV) volume load are reflected by enlarged LA volumes.…”

“…Therefore, accurate assessment and reference values of LA volume and phasic function may be of value and can increase our ability to detect diastolic dysfunction of the LV. 1 Measurement of LA volumes, rather than area or diameter, is recommended for LA assessment (Simpson rule). 10 However, two-dimensional (2D) echocardiographic methods are dependent on geometric assumptions and are prone to errors associated with foreshortening.…”