Renewed Interest in Left Atrial Function: What do we Need to Evaluate Clinically?

Abstract

The use of a Swan-Ganz catheter has resulted in the accurate evaluation of the severity of acute left heart failure, making it possible to establish appropriate therapeutic strategies for this disorder using Forrester s classification. The routine use of clinical echocardiography has facilitated the noninvasive diagnosis of hemodynamic abnormalities related to various disease conditions. In particular, transmitral flow (TMF) and pulmonary venous flow (PVF) velocity patterns, acquired by the pulsed Doppler method, have led to the establishment of a new clinical field, diastology [1].Previously, the left ventricle (LV) was the focus of investigation when evaluating left heart function, and the left atrium (LA) was considered to have a minor supporting role. However, recent studies have focused on the role of the LA, because it has been recognized that a thorough understanding of LA performance is essential to evaluate more accurately left heart diseases [2]. When evaluating LV function clinically, hemodynamic abnormalities in the pulmonary vein-LA-LV relationship should always be considered, and echocardiography may be an indispensable tool for obtaining important information concerning the relationship between the pulmonary veins and LV with the LA playing a central role.In this review, we summarize how to evaluate LA function using echocardiography with the role of LA function in patients with left-side heart failure. Basic UnderstandingLeft atrial function is classified into 3 categories based on hemodynamic characteristics [3-6]: 1) reservoir function for blood returning from the pulmonary veins due to active relaxation and passive expansion of the LA during ventricular systole; 2) conduit function promoting direct blood inflow from the pulmonary veins to the LV during ventricular diastole; and 3) booster pump function that is responsible for active ejection of blood into the LV during atrial systole.The blood inflow from the pulmonary veins to the LA and that from the LA to the LV can be evaluated by pulsed Doppler echocardiography based on the PVF velocity pattern (Figure 1, PVF) and the TMF velocity pattern (Figure 1, TMF). Because LA filling and emptying are involved in the hemodynamic relationship between the pulmonary veins, LA and LV, the LA appendage flow velocity pattern (Figure 1, LAAF), recorded by pulsed Doppler echocardiography, and the mitral annular motion velocity pattern (Figure 1, MAMV), recorded by tissue Doppler imaging, also may be important indices for assessing LA function in addition to the LA size determined by M-mode and 2-and 3-dimensional echocardiography, which assess

Negative Impact of Cardiovascular Risk Factors on Left Atrial and Left Ventricular Function Related to Aortic Stiffness

“…The degree of elevated LV filling pressure, however, may not fully explain LA dysfunction, and LA myocardial fibrosis may play a key role in the LA systolic and diastolic dysfunction. 23- 26 The increase in E/e'/S-LAs and decrease in peak early diastolic LV longitudinal strain rate suggest an increased LA stiffness during ventricular systole and an impaired LV relaxation, respectively. 10, 18 These findings are likely to be explained by normal or intermediate E/e' in the present patients, suggesting that LA stiffness is already increased, even when LV filling pressure is not so elevated.…”

Left Atrial Dyssynchrony in Patients With Nonobstructive Hypertrophic Cardiomyopathy Evaluated by Myocardial Strain Imaging

“…The E/Ea, a represent noninvasive measure of LV filling pressure [11], however, did not differ between patients with and without LA dyssynchrony. In addition, assessment of pulmonary venous flow profiles could have complemented the interpretation of our data [25,26], especially relationship between the systolic component and reservoir dyssynchrony. Some of the patients had hypertension, and thus possible influence of antihypertensive regimens on LA functional parameters could not be excluded.…”

Echocardiographic Features of Patients With Congestive Heart Failure and Preserved Left Ventricular Pump Function: A Retrospective Study in a Selected Common Disease Cohort

“…The recent widespread use of pulsed Doppler echocardiography has facilitated TMF and pulmonary venous flow (PVF) velocity recording in clinical practice, and the important role of the left atrium in the pulmonary vein-left atrium-LV relationship has been recognized [11]. According to previous studies [1][2][3] CHF, congestive heart failure; ns, not significant.…”