Right and left atrial appendage function in patients with mitral stenosis and sinus rhythm

Abstract

Tissue Doppler imaging (TDI) is generally used for the assessment of ventricular function, and to a lesser extent, to evaluate the left atrial appendage (LAA). In the present study, we used TDI to analyze the contractile function of the right atrial appendage (RAA). The aim of this study was a comprehensive evaluation of RAA and LAA contractile function in patients with mitral stenosis and sinus rhythm. A total of 69 patients were assessed: group 1 (23 patients with severe MS, 38 +/- 11 years, 20 women), group 2 (23 patients with mild MS, 39 +/- 12 years, 19 women) and group 3 (23 healthy subjects, 42 +/- 14 years, 16 women). Multiplane transesophageal echo was performed in all patients. The RAA was visualized at 130 degrees and the LAA at 0 degrees . TDI sample volume was placed in the tip of both atrial appendages, with an ultrasound beam angle < 10 degrees . Flow velocities and myocardial velocities were measured. The presence of thrombus and/or spontaneous echo contrast (SEC) was assessed. TDI showed in normal subjects, myocardial contraction velocities in RAA similar to that of the LAA (21.8 +/- 4.2 vs. 20.1 +/- 4 cm/s, respectively, P = NS). In patients with MS, myocardial velocities in both atrial appendages were significantly lower than in normal subjects (RAA: 17.4 +/- 5.1 vs. 21.8 +/- 4.2 cm/s, respectively, P < 0.01, LAA: 9 +/- 5.1 vs. 20.1 +/- 4 cm/s, respectively, P < 0.001). Linear regression analysis showed a correlation between the impairment of systolic function of both appendages, pulmonary arterial pressure, valve area and transmitral gradient. Of the 46 patients with MS, patients with intense SEC had lower flow and myocardial velocities in the LAA than patients without SEC (16 +/- 5 vs. 50 +/- 3 cm/s, 6 +/- 2 vs. 10.6 +/- 5.6 cm/s, respectively, P < 0.001 and P < 0.001). In healthy subjects, myocardial contraction velocities in both appendages were similar. Patients with MS and sinus rhythm had contractile dysfunction of both appendages, shown by the decrease in myocardial velocities and related to the increase in atrial afterload. Both appendages exhibited a relation between contractile dysfunction and the presence of SEC, but dysfunction was less marked in the RAA, which might explain the lower prevalence of thrombi in the RAA.

Structural Comparison between the Right and Left Atrial Appendages Using Multidetector Computed Tomography

“…Thrombus formation may occur less often in RAA than in LAA not only because of contractile dysfunction, as evidenced by a stronger spontaneous contrast echo, and decreased flow rate [3, 18], but also because of other causes, such as morphological differences, which we discovered between RAA and LAA. Di Biase et al [26] classified LAA into four categories based on the morphology (cactus, chicken wing, windsock, and cauliflower types) and reported that patients with non-chicken wing LAA morphology are significantly more likely to have an embolic event.…”

“…Then, silicon molds of AA from each heart were produced, which included a portion of the neck between RAA and LAA (silicone acrylic hybrid resin; Nissin Chemical Industry Co., Ltd., Echizen, Japan; mixing ratio of resin to hardener, 100 : 5 w/w; curing time, 7 days). The neck portion of RAA and LAA was defined as the entrance part of the AA for measurement using TEE [7, 18]. The RAA was measured in conjunction with the two parts divided by the tenia sagittalis.…”

Experimental Impact of Mucopolysaccharidosis on Right Atrial Contractile Capacity of Skinned Fibers

“…Referring to studies about contractility of right atrial appendage in patients with MS, contractile dysfunction can already be seen in patients with MS and sinus rhythm [15]. The decrease was related to increase in atrial afterload.…”

Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation

“…Other authors reported that non-valvular AF resulted in significant morphological and functional changes of the RAA compared to patients with SR, with increased area and decreased fractional area change and blood flow velocity into RAA, which can be measured by pulsed wave Doppler (Fig. 6) [60,61].…”

“…For example, the diagnostic and prognostic indicators of velocities of medial and lateral walls of the RAA were studied using pulsed wave TDI [58,61,62]. For this purpose, the images of the RAA by TEE were obtained and the sample volume (size: 2 mm) of corresponding walls of RAA was determined by activating pulsed wave TDI (Fig.…”