Differential Left Atrial Remodeling in LV Diastolic Dysfunction and Mitral Regurgitation

Maiello, Maria; Sharma, F.A.C.C. Rakesh K.; Ciccone, Marco Matteo; Reddy, F.A.C.C. Humananth K.; Palmiero, Pasquale

doi:10.1111/j.1540-8175.2008.00889.x

Cited by 13 publications

(10 citation statements)

References 34 publications

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“…Therefore, the echocardiographic assessment of LA function is increasingly being employed in the diagnosis and investigation of various cardiac abnormalities [9,10]. To date, attention has mostly been given to LA systolic function [11][12][13][14][15]. This interest in the evaluation of active LA contraction has been obviously motivated by the well-known contribution of LA ''booster'' pump to cardiac output.…”

Section: Introductionmentioning

confidence: 99%

Left atrial flow propagation velocity: a new approach for assessment of left atrial reservoir function

Paleček

Lubanda

Trckova

et al. 2010

Int J Cardiovasc Imaging

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To assess the feasibility of left atrial flow propagation velocity (LAFPV) measurement and to evaluate the influence of preload alterations on this new parameter of left atrial (LA) reservoir function as compared to conventional echocardiographic indices. 30 healthy volunteers (26 ± 5 years, 20 males) underwent echocardiographic examination at rest, during passive leg lifting and after sublingual administration of nitroglycerine with subsequent Valsalva maneuver. LA reservoir function was assessed by conventional indices including LA expansion index, peak velocity and velocity-time integral of pulmonary venous systolic flow. As well, LAFPV was measured by color M-mode in an apical 4-chamber view as the slope of the transatrial flow wave during LA reservoir phase. LAFPV measurement was feasible in 25 subjects (83%). All conventional parameters of LA reservoir function were significantly altered from resting values by both load-modifying conditions. However, LAPFV was not significantly altered by such maneuvers (228 ± 28 cm s⁻¹ at rest vs. 238 ± 3 cm s⁻¹ during leg lifting, P = NS, vs. 218 ± 38 cm s(-1) after nitroglycerin with Valsalva maneuver, P = NS vs. rest, P < 0.01 vs. leg lifting). LAFPV can be measured in a majority of subjects and represents a new, less load-dependent index of LA reservoir function that may more appropriately reflect LA compliance.

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Section: Introductionmentioning

confidence: 99%

Left atrial flow propagation velocity: a new approach for assessment of left atrial reservoir function

Paleček

Lubanda

Trckova

et al. 2010

Int J Cardiovasc Imaging

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“…Mitral regurgitation has a well-recognized association with AF, 78 and more severe mitral regurgitation has been shown to predict progression from paroxysmal AF to permanent AF, 79 incident AF after myocardial infarction, 80 and AF recurrence after PV isolation. 81 A study by Maeillo et al 82 noted that LA enlargement in the setting of mitral regurgitation tends to be more spherical than that occurring with diastolic dysfunction, which tends to be more eccentric, suggesting that the more spherical modeling is more relevant to the development of AF. However, a study by Gertz et al 83 found that mitral regurgitation tended to improve with restoration of sinus rhythm, implying that AF itself can exacerbate mitral regurgitation.…”

Section: Clinical Studies Of Af and Diastolic Dysfunctionmentioning

confidence: 99%

Diastolic Dysfunction and Risk of Atrial Fibrillation

2012

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A trial fibrillation (AF) is the most common sustained arrhythmia, and its prevalence in the population is increasing. 1 Diastolic dysfunction shares many common risk factors with AF, including age, hypertension, 2-5 obesity, 6,7 and diabetes. 8,9 Like AF, diastolic dysfunction increases with age, 10 and patients given the diagnosis of diastolic dysfunction are more likely to have AF at the time. 11 Diastolic dysfunction has significant pathological effects on atrial structure and function, many of which are proarrhythmic. However, much remains to be learned about the specific mechanisms through which diastolic dysfunction ultimately promotes AF.Previous reviews have examined the broad association of diastolic dysfunction and AF. 12 In this review, we attempt to examine this association on a mechanistic level. We begin with a basic review of the physiology of diastolic function, with particular attention to the complex interaction between the atrium and the ventricle during diastole. We then provide an overview of some of the most common clinical methods to quantify diastolic function and highlight the strengths and weaknesses of these methods with regard to providing an accurate picture of this physiology. We describe how these methods are applied to diagnose diastolic dysfunction, including the development of a widely adopted classification scheme of diastolic dysfunction. We then review the limited clinical data available connecting diastolic dysfunction with the risk of incident, nonvalvular AF, with a focus on studies examining diastolic dysfunction in populations without structural heart disease-ie, with preserved systolic function in the absence of hypertrophic cardiomyopathic disease or congenital heart disease. Finally, we attempt to reconcile the results of these clinical studies with experimental data in both human, animal, and cellular models, to create a mechanistic link between diastolic dysfunction and pathological changes that increase the likelihood of AF. Atrial and Ventricular Diastolic DynamicsA number of excellent resources are available for more detailed review of the dynamics of ventricular diastole, including invasive 13 and noninvasive 14 -17 descriptions. Ventricular diastole is the period of the cardiac cycle that begins with the closure of the aortic valve and ends with mitral valve closure, during which the ventricle is filling with blood. It can be further divided into 4 sequential components: (1) isovolumic relaxation, (2) early rapid filling, (3) diastasis, and (4) atrial systole (late filling). Dynamically, none of the components is completely independent of each other, or the systolic function of the heart, and changes in one can influence the others in predictable and unpredictable ways.Essentially, there are 2 characteristics of ventricular function that contribute to diastolic function: relaxation (lusitropy) and compliance. Relaxation refers to the process by which the ventricular pressure drops after contraction to a level below that of the atrium, causing blood to flow dow...

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“…LAVi was obtained by LAVs indexed by body surface area. The sphericity of LA was assessed by LA eccentricity index (LAEi) [11]. Parameters of LV diastolic function were determined from transmitral inflow velocities using pulsed wave Doppler recordings in the apical 4-chamber view.…”

Section: Standard Echocardiographymentioning

confidence: 99%

Echocardiographic parameters versus CHA2DS2-VASc score in prediction of overall cardiac events, heart failure, and stroke in non-valvular atrial fibrillation

Yang

Tsai

2018

Cardiol J.

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Differential Left Atrial Remodeling in LV Diastolic Dysfunction and Mitral Regurgitation

Cited by 13 publications

References 34 publications

Left atrial flow propagation velocity: a new approach for assessment of left atrial reservoir function

Left atrial flow propagation velocity: a new approach for assessment of left atrial reservoir function

Diastolic Dysfunction and Risk of Atrial Fibrillation

Echocardiographic parameters versus CHA2DS2-VASc score in prediction of overall cardiac events, heart failure, and stroke in non-valvular atrial fibrillation

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