The importance of integrated left atrial evaluation: From hypertension to heart failure with preserved ejection fraction

Abstract

SummaryAim: Functional analysis and measurement of left atrium are an integral part of cardiac evaluation, and they represent a key element during non-invasive analysis of diastolic function in patients with hypertension (HT) and/or heart failure with preserved ejection fraction (HFpEF). However, diastolic dysfunction remains quite elusive regarding classification, and atrial size and function are two key factors for left ventricular (LV) filling evaluation. Chronic left atrial (LA) remodelling is the final step of chronic intracavitary pressure overload, and it accompanies increased neurohormonal, proarrhythmic and prothrombotic activities. In this systematic review, we aim to purpose a multi-modality approach for LA geometry and function analysis, which integrates diastolic flow with LA characteristics and remodelling through application of both traditional and new diagnostic tools. Methods:The most important studies published in the literature on LA size, function and diastolic dysfunction in patients with HFpEF, HT and/or atrial fibrillation (AF) are considered and discussed. Results:In HFpEF and HT, pulsed and tissue Doppler assessments are useful tools to estimate LV filling pressure, atrio-ventricular coupling and LV relaxation but they need to be enriched with LA evaluation in terms of morphology and function. An integrated evaluation should be also applied to patients with a high arrhythmic risk, in whom eccentric LA remodelling and higher LA stiffness are associated with a greater AF risk. Conclusion:Evaluation of LA size, volume, function and structure are mandatory in the management of patients with HT, HFpEF and AF. A multi-modality approach could provide additional information, identifying subjects with more severe LA remodelling.Left atrium assessment deserves an accurate study inside the cardiac imaging approach and optimised measurement with established cut-offs need to be better recognised through multicenter studies.

Cardiovascular Changes in Patients With COVID-19 From Wuhan, China

“…Epidemiological studies indicate that the prevalence of diastolic dysfunction of varying severity in hypertensive patients is 60% (37). Chronic LA remodeling is the final step of chronic intracavitary pressure overload, resulting in LA enlargement (38). The exceedingly high incidence of LV diastolic dysfunction (73.7%) and LA enlargement (57.9%) in our COVID-19 cohort could not be simply explained by the preexisting hypertension alone.…”

Handheld Ultrasound and Focused Cardiovascular Echography: Use and Information

“…In atrial fibrillation , FoCUS defines left atrial dimensions (dilatation) and left ventricular function, which are strong predictors of sinus rhythm restoration and lead to proper treatment [21,22].…”

Left Atrial Phasic Function in Patients with Hypertension and Recurrent Atrial Fibrillation: Gender Differences of the Relationship with Diastolic Dysfunction and Central Aortic Pressure

“…Основным субстратом фибрилляции предсердий (ФП) является структурно-функциональная перестройка левого предсердия (ЛП), выраженность которой прямо связана как с утяжелением клинического варианта течения аритмии [1], так и с развитием ее осложнений -инсульта [2,3], хронической сердечной недостаточности [4] и смерти [3,5]. Поэтому особенностям ремоделирования ЛП в различных клинических ситуациях и факторам, приводящим к его развитию, уделяется особое внимание [6]. Возможно, в этой же плоскости находятся гендерные различия в риске тромбоэмболических осложнений, прямо связанных с выраженностью морфо-функциональных изменений ЛП [7,8].…”