Evaluation of left atrial systolic function in noncompaction cardiomyopathy by real-time three-dimensional echocardiography

Abstract

Background Noncompaction cardiomyopathy (NCCM) is a rare disorder with persistance of the embryonic pattern of myoarchitecture. NCCM is characterized by loosened, spongy myocardium associated with a high incidence of systolic and diastolic left ventricular (LV) dysfunction and heart failure (HF). It is known that LV dysfunction contributes to elevated left atrial (LA) and pulmonary vascular pressures, however atrial function has not been examined in NCCM. The objective of the present study was to assess LA systolic function characterized by LA ejection force (LAEF) in NCCM patients using real-time three-dimensional echocardiography (RT3DE) and to compare to control subjects. Methods The study comprised 17 patients with an established diagnosis of NCCM and their results were compared to 17 healthy age-matched controls with no evidence of cardiovascular disease. Forty-one percent of NCCM patients were in NYHA functional class II / III HF. Previously proposed echocardiographic diagnostic criteria for NCCM were used. All patients underwent conventional two-dimensional echocardiography and RT3DE. LAEF was measured based on MA annulus diameter (LAEF 3D-MAD ) and area (LAEF 3D-MAA ) using RT3DE. Results The presence and severity of mitral regurgitation were more frequent in NCCM patients than in control subjects. LV diameters and mitral annulus were significantly increased in NCCM patients. Compared with control subjects, both LAEF 3D-MAD (3.8 ± 2.2 vs 2.3 ± 1.0 kdyne, P \ 0.05) and LAEF 3D-MAA (12.7 ± 7.6 vs 4.9 ± 2.1 kdyne, P \ 0.01) were significantly increased in NCCM patients. Conclusions LAEF as a characteristic of LA systolic function is increased in NCCM patients compared to normal individuals. These results can suggest compensating left atrial work against the dysfunctional LV in NCCM patients.

Advances in the assessment of left atrial function by three-dimensional speckle tracking echocardiography

“…MA could be also assessed 'en-face' by RT3DE and was found to be enlarged and functionally impaired in NCCM patients, with a higher incidence and severity of MR (10). LA-EFO was increased in NCCM patients compared to normal individuals suggesting compensating LA work against the dysfunctional LV in NCCM patients (26). 3D-STE-derived LA-EFO of the present NCCM case was in the range previously given by RT3DE (26).…”

“…Because A wave acceleration is relatively constant, it can be approximated as the peak A velocity divided by the time to peak A velocity (25). Using MAD and MAA data, LA-EFO 3D-MAD and LA-EFO 3D-MAA were calculated using the following equation: LAEFO= 0.5×1.06×(MAD 3D or MAA 3D )×V 2 (25,26), where 0.5 is a coefficient factor. LA-EFO 3D-MAD and LAEFO 3D-MAA were 3.8 kdyne and 13.5 kdyne in this case.…”

Focus on atrial function: benefits of three-dimensional speckle-tracking echocardiography

“…However, relatively low number of studies are available, in which LA (dys)function was investigated in NCCM. In a recent RT3DE study, LA ejection force was found to be increased in NCCM as compared to controls (13,21).…”

“…LAEFO is based on classic Newtonian mechanics and is a potential useful index for assessing atrial contribution to diastolic performance (28). Over 2D imaging both 3D echocardiographic techniques, RT3DE (14,21,37) and 3DSTE (13) have been demonstrated to be practicable in assessing LAEFO using Doppler-derived mitral inflow A velocity. However, to the best of authors' knowledge this is the first time to examine whether correlations exist between 3DSTE-derived LAEFO and LA volume-based and strain funtional properties respecting cardiac systolic and diastolic functions in healthy subjects.…”

“…It usually presents with ventricular dysfunction, thromboembolic events and arrhythmias. However, little is known about the behaviour of LA in noncompaction cardiomyopathy (NCCM) (13,21).…”