Assessment of left sided filling dynamics in diastolic dysfunction using cardiac computed tomography

Schweitzer, Ariel; Agmon, Yoram; Aronson, Doron; Abadi, Sobhi; Mutlak, Diab; Carasso, Shemy; Walker, Jonathan R.; Lessick, Jonathan

doi:10.1016/j.ejrad.2015.07.006

Cited by 14 publications

(4 citation statements)

References 34 publications

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“…We have already demonstrated that conduit contribution to LV filling increases with worsening of diastolic dysfunction [ 10 ] and that such parameter could be proposed for evaluation of diastole [ 32 ]. It is important to note that other authors, using cardiac computed tomography, have similarly demonstrated that diastolic dysfunction is characterized by increasing of conduit volume [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion

et al. 2017

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BackgroundDiastolic dysfunction promotes atrial fibrillation (AF) inducing left atrial (LA) remodeling, with chamber dilation and fibrosis. Predominance of LA phasic conduit (LAC) function should reflect not only chamber alterations but also underlying left ventricular (LV) filling impairment. Thus, LAC was tested as possible predictor of early AF relapse after electrical cardioversion (EC).Methods96 consecutive patients, who underwent EC for persistent non-valvular AF, were prospectively enrolled. Immediately after successful EC (3 h ± 15 min), an echocardiographic apical four-chamber view was acquired with transmitral velocities, annular tissue Doppler and simultaneous LV and LA three-dimensional full-volume datasets. Then, from LA–LV volumetric curves we computed LAC as: [(LV maximum − LV minimum) − (LA maximum − LA minimum) volume], expressed as % LV stroke volume. LA pump, immediately post-EC, was assumed and verified as being negligible. Sinus rhythm persistence at 1 month was checked with ECG-Holter monitoring.ResultsAt 1 month 62 patients were in sinus rhythm and 34 in AF. AF patients presented pre-EC higher E/é values (p = 0.012), no major LA volume differences (p = NS), but a stiffer LV cavity (p = 0.012) for a comparable LV capacitance (p = 0.461). Conduit contributed more (p < 0.001) to LV stroke volume in AF subpopulation. Multiple regression revealed LAC as the most significant AF predictor (p = 0.013), even after correction for biometric characteristics and pharmacotherapy (p = 0.008).ConclusionOur data suggest that LAC larger contribution to LV filling soon after EC reflects LA–LV stiffening, which skews atrioventricular interaction leading to AF perpetuation and makes conduit dominance a powerful predictor of early AF recurrence.Electronic supplementary materialThe online version of this article (10.1007/s00392-017-1188-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion

et al. 2017

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“…Among patients with clinical heart failure, at least half have heart failure with preserved ejection fraction. Cardiac CTA may be used to derive surrogate markers of diastolic dysfunction by evaluating the change in mitral valve area, mitral septal tissue motion, changes in LV volume, and left atrial total emptying fraction . However, further work is required to determine the clinical utility of these newer indices.…”

Section: Ventricular Structure and Functionmentioning

confidence: 99%

Emerging role of cardiac computed tomography in heart failure

et al. 2019

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Despite medical advancements, the prognosis of patients with heart failure remains poor. While echocardiography and cardiac magnetic resonance imaging remain at the forefront of diagnosing and monitoring patients with heart failure, cardiac computed tomography (CT) has largely been considered to have a limited role. With the advancements in scanner design, technology, and computer processing power, cardiac CT is now emerging as a valuable adjunct to clinicians managing patients with heart failure. In the current manuscript, we review the current applications of cardiac CT to patients with heart failure and also the emerging areas of research where its clinical utility is likely to extend into the realm of treatment, procedural planning, and advanced heart failure therapy implementation.

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Section: Methodsmentioning

confidence: 99%

“…19,20 LA expansion index, representing the relative LA volume changes during the reservoir phase, was calculated as follows: LA expansion indexI=(LAV max −LAV min )/LAV min . 15,16,18,[21][22][23] Based on these calculations, LV filling was divided into 3 volumetric components: (1) early passive emptying volume; (2) late active (booster) volume; and (3) conduit volume, defined as the volume of blood that passes through the LA that cannot be accounted for by early or booster-pump function: LV SV−(LA max volume-LA min volume). 2 These components of the LA function were expressed in terms of LV filling as a percent contribution to LV SV.…”

Section: Asmentioning

confidence: 99%

Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction

Aronson,

Sliman,

Abadi

et al. 2024

Circ: Cardiovascular Imaging

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BACKGROUND: Quantification of left atrial (LA) conduit function and its contribution to left ventricular (LV) filling is challenging because it requires simultaneous measurements of both LA and LV volumes. The functional relationship between LA conduit function and the severity of diastolic dysfunction remains controversial. We studied the role of LA conduit function in maintaining LV filling in advanced diastolic dysfunction. METHODS: We performed volumetric and flow analyses of LA function across the spectrum of LV diastolic dysfunction, derived from a set of consecutive patients undergoing multiphasic cardiac computed tomography scanning (n=489). From LA and LV time-volume curves, we calculated 3 volumetric components: (1) early passive emptying volume; (2) late active (booster) volume; and (3) conduit volume. Results were prospectively validated on a group of patients with severe aortic stenosis (n=110). RESULTS: The early passive filling progressively decreased with worsening diastolic function ( P <0.001). The atrial booster contribution to stroke volume modestly increases with impaired relaxation ( P =0.021) and declines with more advanced diastolic function ( P <0.001), thus failing to compensate for the reduction in early filling. The conduit volume increased progressively ( P <0.001), accounting for 75% of stroke volume (interquartile range, 63–81%) with a restrictive filling pattern, compensating for the reduction in both early and booster functions. Similar results were obtained in patients with severe aortic stenosis. The pulmonary artery systolic pressure increased in a near-linear fashion when the conduit contribution to stroke volume increased above 60%. Maximal conduit flow rate strongly correlated with mitral E-wave velocity (r=0.71; P <0.0001), indicating that the increase in mitral E wave in diastolic dysfunction represents the increased conduit flow. CONCLUSIONS: An increase in conduit volume contribution to stroke volume represents a compensatory mechanism to maintain LV filling in advanced diastolic dysfunction. The increase in conduit volume despite increasing LV diastolic pressures is accomplished by an increase in pulmonary venous pressure.

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Assessment of left sided filling dynamics in diastolic dysfunction using cardiac computed tomography

Cited by 14 publications

References 34 publications

Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion

Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion

Emerging role of cardiac computed tomography in heart failure

Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction

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