Relationship of phasic left atrial volume and emptying function to left ventricular filling pressure: a cardiovascular magnetic resonance study

Abstract

BackgroundLeft atrial volume (LAV) and emptying fraction (LAEF) are phasic during cardiac cycle. Their relationships to left ventricular end diastolic pressure (LVEDP) have not been fully defined.MethodsForty one patients undergoing clinically indicated left heart catheterization were recruited for same day cardiovascular magnetic resonance (CMR). LAV and LAEF were assessed in cine images using biplane area and length method. Three phasic LAV was assessed at LV end systole (LAVmax), LV end diastole (LAVmin) and late LV diastole prior to LA contraction (LAVac). LAEF was assessed as global LAEF (LAEFTotal), passive (LAEFPassive) and active LAEF (LAEFContractile). The relationships of phasic LAV and LAEF to LVEDP were assessed using Receiver operating characteristic comparing areas under the curves (AUC).ResultsThe mean age of the patients was 59 years. A history of heart failure was present in 16 (39%) with NYHA functional class III or IV in 8 (20%) patients. Average LV ejection fraction was 49 ± 16% ranging from 10% to 74% and LVEDP by catheterization 14 ± 8 mmHg ranging from 4 mmHg to 32 mmHg. LAVmin had the strongest association with LVEDP elevation (>12 mmHg) (AUC 0.765, p = 0.002), as compared to LAVmax (AUC 0.677, p = 0.074) and LAVac (AUC 0.735, p = 0.008). Among three phasic LAEF assessed, LAEFTotal had the closest association with LVEDP elevation (AUC 0.780, p = 0.001), followed by LAEFContractile (AUC 0.698, p = 0.022) and LAEFPassive (AUC 0.656, p = 0.077).ConclusionsIncreased LAVmin and decreased LAEFTotal have the best performance in identifying elevated LVEDP among three phasic LAV and LAEF analyzed. Future studies should further characterize LA phasic indices in clinical outcomes.

Hypertensive patients with left ventricular hypertrophy have global left atrial dysfunction and impaired atrio-ventricular coupling

“…Surprisingly, studies based on VVI demonstrated normal LA reservoir function, even in patients with major LV hypertrophy [10,11]. Elevated LV filling pressures related to LV diastolic dysfunction have been considered to be the main underlying mechanism of LA dysfunction in patient with HTN and LV hypertrophy [20,21]. Several recent findings suggest that LA myocardial fibrosis may also play a role [22,23], and that the degree of elevated LV filling pressure is only modestly correlated to LA reservoir function, as in our study.…”

Association of CMR-Measured LA Function With Heart Failure Development

“…In 1 study of patients with HFNEF, Russo et al (37) demonstrated that the LAV min increases even in mild diastolic dysfunction, whereas an increase in LAV max was only seen in later stages of systolic dysfunction. In the other study of 41 patients undergoing cardiac catheterization, among the LA volumes, LAV min was the most sensitive identifier of LV end-diastolic pressure (38). …”

Atrial remodelling in heart failure: recent developments and relevance for heart failure with preserved ejection fraction

“…In chronic conditions, LA volume and strain correlate with LV end‐diastolic pressures irrespective of EF 75, 76. Mechanical stress induces stretching and stiffening of the atria 77.…”