Analysis of Left Atrial Volume Change Rate for Evaluation of Left Ventricular Diastolic Function

Abstract

An excellent correlation exists between the change in the left atrial (LA) angiographic area and posterior aortic wall motion. The aim of the study was to define the role of posterior aortic wall motion, indicating LA volume change, during the left ventricular (LV) phase for the assessment of LV diastolic function. A total of 155 patients underwent echocardiography after cardiac catheterization. Study patients were classified into four groups according to the ratio of early-to-late transmitral flow velocity (E/A ratio) and/or LV end-diastolic pressure (EDP): 42 patients with LVEDP < 15 mmHg and E/A ratio > 1 (normal filling); 46 patients with E/A < 1 (impaired relaxation); 46 patients with LVEDP > or = 15 mmHg and E/A > 1 and < 2 (pseudonormal filling); 21 patients with E/A > 2, E > or = 70 cm/s, and E-wave deceleration time < or = 160 ms (restrictive filling). The slopes of early and late (slopes E and A) diastolic motion of LA wall were derived from M-mode analysis, together with the LV isovolumic time constant Tau from cardiac catheterization. Values of slope E/A decreased in restrictive filling, pseudonormal filling, and impaired relaxation as compared with normal filling (0.41 +/- 0.14, 0.69 +/- 0.15, and 0.56 +/- 0.23 vs 1.25 +/- 0.26, P < 0.001, respectively) and correlated inversely with the isovolumic time constant Tau (r = 0.79, P < 0.001). In cases for which a value of slope E/A < 1 was obtained, indicating a relaxation abnormality, the M-mode derived pattern of LA wall motion identified the underlying abnormal LV diastolic function with a sensitivity of 98.3%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 95.2%. Analysis of the slope of LA wall motion, indicating LA volume change rate, during LV diastolic phase is useful in evaluating LV diastolic function. It provides a new noninvasive index that correlates well with invasive index of LV relaxation.

Increased left atrial volume index is an independent predictor of raised serum natriuretic peptide in patients with suspected heart failure but normal left ventricular ejection fraction: Implication for diagnosis of diastolic heart failure

“…Indeed a number of investigators have even demonstrated the utility of LAVI in predicting cardiovascular outcomes in an unselected community screening programme [20,28]. These observations coupled with recent studies suggesting that LA volume change rate (d[LAVI]/d t ) during diastole is useful in evaluating DD [36] provide a rationale supporting our observations relating LAVI and DD. The putative mechanism for this association may relate directly to the role of increased LV filling pressures acting through an open mitral valve orifice, affecting an increased wall tension and as a consequence of LaPlace's law causing left atrial distension.…”

Association of Left Atrial Booster‐Pump Function with Heart Failure Symptoms in Patients with Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction

“…Similarly, the development of HF symptoms has previously been demonstrated to be associated with the degree of AS severity and LV hypertrophy in patients with AS. On the other hand, other studies have demonstrated that LV diastolic function rather than systolic function plays an important role in determining exercise performance by patients with HF, and changes in LA size have been termed a valuable parameter for monitoring LV diastolic function in patients with HF . Assessment of LA functions may therefore be clinically useful because, unlike instantaneous Doppler measurements, it represents not only the severity of LV diastolic dysfunction but also its chronicity.…”

Left atrial shortening fraction in fetuses with and without myocardial hypertrophy in diabetic pregnancies

“…Several studies have found an association between increased ventricular filling pressure and increased left atrial volume, with changes in its diameter correlating with an increase in risk10–16. In adults with myocardial hypertrophy, left atrial shortening may be more reliable in the assessment of diastole than mitral Doppler17–21. It is a stable and reliable parameter that reflects the duration and severity of diastolic dysfunction.…”