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

Abstract

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.

Left atrial inflow propagation velocity derived by color M-mode Doppler in acute heart failure

“…Mean LAIF-PV in our study was 24.2 cm/s, which is markedly lower than that previously reported in healthy volunteers (228 cm/s) and in critically ill patients (40 cm/s) [ 12 , 22 ]. A discrepancy likely explained by different clinical settings.…”

“…Palecek et al measured LAIF-PV with TTE under different loading conditions (leg raise, sublingual nitro) in 30 healthy adults (mean age 26 years, without known structural heart disease) [ 12 ]. They evaluated 83% of available images and found a strong correlation between LAIF-PV and LA reservoir function measures.…”

“…They evaluated 83% of available images and found a strong correlation between LAIF-PV and LA reservoir function measures. They found LAIF-PV to be less dependent on different loading conditions than other measures of LA reservoir function (LAEI and peak systolic pulmonary venous flow velocity) and suggested that LAIF-PV is a new measure for LA reservoir function, independent of loading conditions [ 12 ]. We failed to confirm this association between LAIF-PV and markers of LA reservoir function in the present study of AHF patients.…”

“…If the slope of the transition of the first aliasing velocity could not be sufficiently defined, we measured the slope of the transition at the interface from no color to color. This method was described previously by Palecek et al, and is a modification of the methods by Brun et al and Garcia et al for color M-mode measurements of transmitral flow velocity [ 11 , 12 , 20 ]. Measurements of LAIF-PV were averaged for 1–3 consecutive cardiac cycles.…”

“…This mode is typically used over the mitral valve and provides information about LV diastolic function [ 11 ]. Recently, LA inflow propagation velocity (LAIF-PV) measured by Color M–mode Doppler of the pulmonary veins was proposed as a novel, non-invasive measure of LA reservoir function [ 13 ], and an independent estimate of PCWP [ 12 , 13 ].…”