Value of the Measurements of Left Atrial Geometry in Patients With Normalized or Restrictive Mitral Flow Velocity Pattern

Abstract

Background. Restrictive or pseudonormalized mitral flow velocity pattern (MFVP) is observed not only in patients with heart failure but also in patients with severe mitral regurgitation (MR). It is important to assess the restrictive MFVP which is primarily due to functional deterioration of the left ventricle or due to MR in individual patients. We hypothesized that left atrial (LA) geometry may be used to estimate restrictive MFVP due to heart failure or MR.Methods. In addition to MFVP and LA chamber size, LA eccentricity index was determined as LA superior-inferior dimension x2/(LA antero-posterior dimension + LA medio-lateral dimension) using 2-dimensional echocardiography in 61 sinus rhythm patients with LA volume of 35 ml or greater. Ten patients had congestive heart failure (CHF group), and 9, severe organic MR (MR group). LV diastolic dysfunction was the most likely explanation for the LA enlargement in the remaining 42 patients (DDF group).Results. There was no difference in mitral E/A ratio (peak early diastolic flow velocity/peak flow velocity at atrial contraction) or in LA chamber size between the MR and CHF groups, but the LA eccentric index was greater in the CHF and DDF groups than in the MR group indicating that LA geometry was spherical in the MR group and elongated in the CHF and DDF groups.Conclusions. Two-dimensional echocardiographic assessment of the LA geometry is useful to determine whether the pseudonormalized or restrictive MFVP is due to functional deterioration of the left ventricle or due to MR. (J Echocardiogr 2005; 3: 109-117)

Left atrial geometry and pump function in ischemic cardiomyopathy

“…The high prevalence of severe diastolic dysfunction and the “elongated” geometry of the left atrium in cardiomyopathy patients suggested a major role of LV filling pattern on LA properties in this group of patients [14]. In order to test this assumption, our 45 cardiomyopathy patients (regardless of etiology) were divided into two groups according to the presence or absence of severe diastolic dysfunction (RFP).…”

“…1 ). We used left atrial eccentricity index (LAEi = {2 × D2} / {D1 + D3}) to assess the changes in the LA shape [14] .…”

Differential Left Atrial Remodeling in LV Diastolic Dysfunction and Mitral Regurgitation

“…LAVi > 40 ml/m 2 is better than LA diameter in predicting AF, death and or mitral valve replacement 9 . Chronic pressure overload may cause an active atrial remodeling, while chronic volume overload may cause a passive atrial remodeling with two different shapes that can be discriminated by LA eccentricity index (LAEi) 10 …”

“…9 Chronic pressure overload may cause an active atrial remodeling, while chronic volume overload may cause a passive atrial remodeling with two different shapes that can be discriminated by LA eccentricity index (LAEi). 10 We hypothesized that LA shape described by LAEi may have a better predictive value for the adverse cardiovascular outcome. The goal of our study was to evaluate the relationship between LV diastolic function, MR, LAVi, and LAEi in a cross-sectional study with a population of 5,450 consecutive patients followed in our heart station with echocardiographic examination.…”

Prognostic implications of left atrial dilation evaluated by echocardiographic volume in patients with normal left atrial antero-posterior dimensions

“…1). A few studies [5][6][7] have demonstrated clinical characteristics of LA dilation evaluated by LAV in patients with normal LAD, but the prognostic implications of the LA dilation have not been investigated. This study was designed to evaluate clinical characteristics and prognosis of LA dilation evaluated by LAV in patients with normal LAD.…”