Left atrial afterload mismatch in hypertrophic cardiomyopathy

Sanada, Hiroto; Shimizu, Masami; Shimizu, Kuniyoshi; Kita, Yoshihito; Sugihara, Norihiko; Takeda, Ryoyu

doi:10.1016/0002-9149(91)90494-6

Cited by 40 publications

(35 citation statements)

References 19 publications

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“…As it had been shown in previous studies [3,4], the present study found that, compared with controls, patients with HCM showed increased LA volumes and decreased LA systolic function (emptying fraction). As with LA dyssynchrony, it was currently observed that the derived indexes were increased throughout the cardiac cycle in the patients.…”

Section: Present Observationssupporting

confidence: 89%

“…Since the heart rate, mitral flow, and annular velocity profiles were similar between the subgroups of patients, it is reasonable to assume that LA in relation to LV myocardial involvement may contribute to the development of LA dyssynchrony. This hypothesis is further supported by previous studies demonstrating a positive correlation between LA size and LV wall thickness [3,4,22] and a higher degree of cell damage and fibrotic change in the thicker ventricular wall [23]. Moreover, it was recently reported in a study of 2-dimensional speckle tracking that patients with HCM had more severe LV dyssynchrony than those with hypertensive heart disease [24].…”

Section: Present Observationssupporting

confidence: 77%

“…These measurements were somewhat large compared with ours, although this discrepancy may be attributed to the differences in patient characteristics, including racial background. A previous study using the 2-dimensional method found that HCM patients had impaired LA systolic function, with a significant decrease in the LA emptying fraction [3]. Similar results were observed in another study that used real-time 3-dimensional echocardiography [4].…”

Section: Echocardiographic Assessment Of La Function In Hcmsupporting

confidence: 75%

“…Hypertrophic cardiomyopathy (HCM) has an extremely hypertrophied LV and is commonly associated with LA enlargement and dysfunction [1,2]. Numerous echocardiographic studies have investigated LA function in patients with a variety of heart diseases [1][2][3][4][5][6][7][8]. In patients with HCM, it is generally accepted that increased LA volume is associated with a higher incidence of LV diastolic dysfunction and cardiac events and more severe LV hypertrophy [2,4].…”

Section: Introductionmentioning

confidence: 99%

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Left Atrial Dyssynchrony in Patients With Nonobstructive Hypertrophic Cardiomyopathy Evaluated by Myocardial Strain Imaging

et al. 2008

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Background. The present study was conducted to examine left atrial (LA) dyssynchrony, determined by echocardiographic myocardial strain imaging, in patients with hypertrophic cardiomyopathy (HCM). Methods.We studied 26 patients with HCM (20 men and 6 women, age, 66 7 years) and 25 normal subjects (controls). Tissue Doppler-based strain images were recorded in the apical 2-, 4-chamber, and long-axis views. The LA strain curve was obtained with the region of interest placed at the 5 LA segments, namely, the atrial septum, lateral wall, inferior wall, anterior wall, and posterior wall. We measured standard deviation (SD) of the time-periods between aortic valve opening and maximal strain (reservoir dyssynchrony index) and SD of the time-periods between mitral valve opening and minimal strain (emptying dyssynchrony index). (40 23 Conclusions. LA dyssynchrony can be present throughout the cardiac cycle in patients with HCM. LA dyssynchrony is more common in the reservoir phase and may be attributed to significant myocardial involvement. (J Echocardiogr 2008; 6: 46-53) Results. Compared with controls, patients with HCM had greater indexes of reservoir

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Section: Present Observationssupporting

confidence: 89%

Section: Present Observationssupporting

confidence: 77%

Section: Echocardiographic Assessment Of La Function In Hcmsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Left Atrial Dyssynchrony in Patients With Nonobstructive Hypertrophic Cardiomyopathy Evaluated by Myocardial Strain Imaging

et al. 2008

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“…Experimental and clinical studies have demonstrated that LA systolic function is affected by (1) the precontraction fiber length, defining the maximum developed force according to the Frank Starling mechanism; [22][23][24] (2) the afterload, becoming a major determinant of LA ejection when the LA preload reaches its limit; 25 (3) the autonomic nervous system, which exhibits a positive inotropic effect via catecholamine release and a negative inotropic effect via the muscarinic receptors; and (4) the rennin-angiotensin system, which exerts a positive inotropic effect via the AT1 receptors. 26,27 The mechanism of atrial systolic dysfunction in cardiac amyloidosis is incompletely understood, although amyloid infiltration of the atrial myocardium may result in a reduction in chamber contractility; 5 however, other mechanisms may also be implicated.…”

Section: Discussionmentioning

confidence: 99%

Left atrial systolic function in primary and familial amyloidosis: Assessment from left atrial volume change

Moyssakis

Triposkiadis

Pantazopoulos

et al. 2004

Clinical Cardiology

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Summary:The severity of left ventricular involvement may differ between primary (PA) and familial amyloidosis (FA). This study examined whether differences in left atrial (LA) systolic function are also present. Twenty-eight patients (18 men, 10 women, aged 59 ± 12 years) with PA, 17 (11 men, 6 women, aged 40 ± 11 years) with FA, and 25 normal controls (18 men, 7 women, aged 56 ± 14 years) underwent transthoracic M-mode, two-dimensional, and Doppler echocardiography. Left atrial volumes were determined at mitral valve (MV) opening (maximal, Vmax), electrocardiographic P wave (onset of atrial systole, Vp), and MV closure (minimal, Vmin) from the apical two-and four-chamber views using the biplane area-length method. Left atrial systolic function was assessed with the LA active emptying volume (ACTEV) = Vp-Vmin and fraction (ACTEF) = ACTEV/Vp. The E/A ratio was increased (1.34 ± 0.93 vs. 0.89 ± 0.3), whereas deceleration time was decreased (168.1 ± 33.7 vs. 196.2 ± 34.2 ms) in PA compared with FA (p<0.05). Vmax and Vp were similar in PA and FA and greater than in the controls (46.6 ± 14 vs. 40 ± 11.4 vs. 27.1 ± 6.3 cm 3 /m 2 , p < 0.01, and 33.4 ± 11.6 vs. 29.7 ± 10.8 vs. 16.8 ± 3.8 cm 3 /m 2 , p < 0.01, respectively). The ACTEV was lower in PA and in the controls than in FA (6.7 ± 2 vs. 6.2 ± 2.2 vs. 8.5 ± 3.3, respectively, p < 0.05). The ACTEF was lower in PA than in FA and both were lower than those in the controls (20 ± 5% vs. 28 ± 7% vs. 36 ± 11%, respectively, p < 0.01). Despite a similar increase in LA volume, LA systolic dysfunction is more pronounced in PA than in FA. This is most likely due to the restrictive left ventricular physiology possibly associated with depressed LA contractility in the former.

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Pathophysiology and Clinical Consequences of Atrial Fibrillation in Hypertrophic Cardiomyopathy

Olivotto¹,

Maron²,

Cecchi³

2004

Diagnosis and Management of Hypertrophic Cardiomyopathy

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Left atrial afterload mismatch in hypertrophic cardiomyopathy

Cited by 40 publications

References 19 publications

Left Atrial Dyssynchrony in Patients With Nonobstructive Hypertrophic Cardiomyopathy Evaluated by Myocardial Strain Imaging

Left Atrial Dyssynchrony in Patients With Nonobstructive Hypertrophic Cardiomyopathy Evaluated by Myocardial Strain Imaging

Left atrial systolic function in primary and familial amyloidosis: Assessment from left atrial volume change

Pathophysiology and Clinical Consequences of Atrial Fibrillation in Hypertrophic Cardiomyopathy

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