Left ventricular Doppler filling pattern in dilated cardiomyopathy: Relation to hemodynamics and left atrial function

Ito, Takahide; Suwa, Michihiro; Otake, Yoshiaki; Moriguchi, Ayaka; Hirota, Yuzo; Kawamura, Keishiro

doi:10.1016/s0894-7317(97)70005-1

Cited by 34 publications

(12 citation statements)

References 29 publications

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“…Patients with impaired LV diastolic performance have increased LA volumes and decreased LA contractility that parallel the severity of diastolic dysfunction, such that patients with severe diastolic dysfunction (restrictive LV-filling pattern) have the largest atrial volumes and the worst LA booster pump function [28], [29], [30].…”

Section: Discussionmentioning

confidence: 99%

Left atrial geometry and pump function in ischemic cardiomyopathy

Abdelghani

Atteia

2014

IJC Heart & Vasculature

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BackgroundMany of the factors that are known to alter left atrial (LA) contractility are present in patients with ischemic cardiomyopathy (ICM). Nevertheless, preservation of LA contractile function in this group of patients was reported in previous studies. The aim of this study was to assess the changes in LA size, geometry and contractile function in ICM.Methods and results60 subjects (age: 49 ± 12 years, 53% males) in sinus rhythm undergoing coronary angiography (CA), were enrolled in this study; 15 subjects as a control group, 30 patients with reduced ejection fraction (EF) and significant coronary artery disease; as the ICM group, and 15 with reduced EF and normal CA; as the dilated cardiomyopathy (DCM) group.LA dimensions, volume, active emptying fraction (ACTEF) and eccentricity index (LAEi) as well as late diastolic velocities of the mitral annulus (a′) and LA free wall (A3) were measured.Compared with the control group, ICM patients had larger LA volume and reduced ACTEF, a′ and A3, with no significant difference between patients with ICM and DCM in any of these parameters. LA eccentricity was, non-significantly, higher in both cardiomyopathy groups than in the control group.ConclusionsPatients with ICM have increased LA volume and reduced LA contractile function in comparison with normal controls. LA enlargement, LA contractile dysfunction and LA geometric changes in ICM are similar to that occurring in DCM. LA size, contractile function and eccentricity may not be reliable in differentiating ischemic from idiopathic dilated cardiomyopathy.

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Section: Discussionmentioning

confidence: 99%

Left atrial geometry and pump function in ischemic cardiomyopathy

Abdelghani

Atteia

2014

IJC Heart & Vasculature

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“…Regardless of their location, atrial conduction disorders cause delayed activation and contraction of the left atrium, with the resultant risk of left heart AV asynchrony 107‐114 …”

Section: Hemodynamic Consequences Of Intra‐ and Interatrial Conductiomentioning

confidence: 99%

Intra‐ and Interatrial Conduction Delay:

Daubert

Pavin

Jauvert

et al. 2004

Pacing Clinical Electrophis

149

122

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Atrial conduction disorders are frequent in elderly subjects and/or those with structural heart diseases, mainly mitral valve disease, hyperthrophic cardiomyopathies, and hypertension. The resultant electrophysiological and electromechanical abnormalities are associated with a higher risk of paroxysmal or persistent atrial tachyarrhythmias, either atrial fibrillation, typical or atypical flutter or other forms of atrial tachycardias. Such an association is not fortuitous because intra- and interatrial conduction abnormalities delays disrupt (spatial and temporal dispersion) electrical activation, thus promoting the initiation and perpetuation of reentrant circuits. Preventive therapeutic interventions induce variable, sometimes paradoxical effects as with the proarrhythmic effect of class I antiarrhythmic drugs. Similarly, atrial pacing may promote proarrhythmias or an antiarrhythmic effect according to the pacing site(s) and mode. Multisite atrial pacing was conceived to correct, as much as possible, abnormal activation induced by spontaneous intra- or interatrial conduction disorders or by single site atrial pacing, which are situations responsible for commonly refractory arrhythmias. Atrial electrical resynchronization can also be used to correct mechanical abnormalities like left heart AV dyssynchrony resulting from intraatrial conduction delays.

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“…Volume unloading in the setting of diastolic ventricular interaction allows increased left ventricular filling. Further studies are needed to determine the therapeutic and prognostic significance of left atrial dysfunction, which was common in patients with a restrictive pattern [100] . Both a reduction in left atrial compliance and atrial systolic function play important roles in heart failure patients with the restrictive transmitral flow pattern [99] .…”

Section: Heart Failurementioning

confidence: 99%

A clinical appraisal of left atrial function

Stefanadis

Dernellis

Toutouzas

2001

European Heart Journal

250

245

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The left atrium modulates left ventricular filling through three components: a phase of reservoir or expansion during systole, a conduit phase during diastole, and an active contractile component (when sinus rhythm is present) during late diastole. This active contractile component of the left atrium has an important role in patients with ventricular dysfunction as a 'booster pump' to augment ventricular volume. Augmented left atrial booster function is one of the mechanisms compensating for decreased early filling in patients with reduced left ventricular compliance, whereas a loss of atrial contraction, as a result of atrial fibrillation or ventricular pacing, reduces cardiac output by approximately 15-20% [1,2] .During exercise left atrial reservoir and booster functions are augmented, whereas conduit function is not; increased reservoir function may play an important role in accelerating left ventricular filling by helping to maintain an enhanced atrioventricular pressure gradient during diastole and also by increasing left atrial booster function through an increase in preload [3] . An isolated decrease in left atrial compliance is associated with relative increases in the conduit function of the left atrium. The ability to optimally redistribute left ventricular filling among reservoir, conduit and boosterpump functions is a potentially important adaptation that may occur in the left atrium in response to changing haemodynamics [4] . Frank-Starling mechanismThe stretch of the atrium was controlled by intra-atrial pressure. The Frank-Starling behaviour of the atrium was manifested as a biphasic increase of the contraction force after increasing the stretch level. The development of the contraction force after step increase of the stretch (intra-atrial pressure from 1 to 3 mmHg) was accompanied by an increase in the amplitude of the calcium transients and a decrease in the time constant of Ca 2+ transient decay. The stretch-activated channel activation led to gradual augmentation of Ca 2+ transients, which modulated the action potentials through increased Na + /Ca 2+ -exchanger inward current. The role of troponin C affinity change was to modulate the Ca 2+ transients, stabilize the diastolic [Ca 2+] i, and presumably to produce the immediate increase of the contraction force after stretch seen in experiments. The same mechanism that caused the normal physiological responses to stretch could also generate arrhythmogenic afterpotentials at high stretch levels in the model [15] .With a stepwise decrease in the pacing rate from 110 beats . min 1 to 70 beats . min 1 , the left atrial dimension increases just before atrial contraction and left atrial systolic shortening increases as well. However, the calculated left ventricular filling volume during atrial systole decreases. The pulmonary venous flow during atrial systole is directed toward the left atrium, and the left atrial influx volume from pulmonary venous flow decreases. With a decrease in the pacing rate, the left atrial Frank-Starling mechanism operates....

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Left ventricular Doppler filling pattern in dilated cardiomyopathy: Relation to hemodynamics and left atrial function

Cited by 34 publications

References 29 publications

Left atrial geometry and pump function in ischemic cardiomyopathy

Left atrial geometry and pump function in ischemic cardiomyopathy

Intra‐ and Interatrial Conduction Delay:

A clinical appraisal of left atrial function

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