The clinical consequences of a stiff left atrium

Mehta, Sanjay S.; Charbonneau, François; Fitchett, David; Marpole, Derek; Patton, Robert D.; Sniderman, Allan D.

doi:10.1016/0002-8703(91)90498-7

Cited by 69 publications

(59 citation statements)

References 8 publications

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“…9,30,45 We observed that impaired LA global systolic function (quantified by total LA EF) 7 correlated with increased PVR and reduced PAC measured directly by cardiac catheterization. Impaired diastolic LA function (LA stiffness) was associated with reduced PAC, a measure of oscillatory PA load.…”

Section: Discussionmentioning

confidence: 75%

Left Atrial Remodeling and Function in Advanced Heart Failure With Preserved or Reduced Ejection Fraction

Melenovský

Hwang

Redfield

et al. 2015

Circ: Heart Failure

408

331

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Section: Discussionmentioning

confidence: 75%

Left Atrial Remodeling and Function in Advanced Heart Failure With Preserved or Reduced Ejection Fraction

Melenovský

Hwang

Redfield

et al. 2015

Circ: Heart Failure

408

331

View full text Add to dashboard Cite

show abstract

“…Our observations do not serve to greatly augment our understanding of the stiff LA syndrome, a syndrome in which, in the absence of mitral regurgitation, patients have reduced LA compliance accompanied by large V waves (i.e., the late-systolic peak in atrial pressure due to venous filling while the atrioventricular valve remains closed) and increased pulmonary systolic pressures (15,20). This syndrome has been thought to increase the load on the RV, thus requiring more energy to propel the blood through the pulmonary vasculature (15), as some patients have gone on to develop right-heart failure (6,15). In dogs with normally compliant LAs, we created artificial, relatively small and shortlasting V waves early and late during systole by suddenly filling the LA by inflation of the counter-pulsation balloon.…”

Section: Discussionmentioning

confidence: 79%

“…Among the clinical syndromes in which wave transmission could be an important, unappreciated factor are the stiff left atrium (LA) syndrome (6,15) and the Bernheim syndrome (1,5,24). To study the transmission of waves generated in the LA, we created a system where a backward-going wave, originating from the LA, could be detected in the proximal pulmonary artery (PA; backward and forward are defined with respect to PA flow.)…”

mentioning

confidence: 99%

Direct and series transmission of left atrial pressure perturbations to the pulmonary artery: a study using wave-intensity analysis

Hollander¹,

Dobson²,

Wang³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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. Direct and series transmission of left atrial pressure perturbations to the pulmonary artery: a study using wave-intensity analysis. Am J Physiol Heart Circ Physiol 286: H267-H275, 2004. First published September 25, 2003 10.1152/ ajpheart.00505.2002-Pressure waves are thought to travel from the left atrium (LA) to the pulmonary artery (PA) only retrogradely, via the vasculature. In seven anesthetized open-chest dogs, a balloon was placed in the LA, which was rapidly inflated and deflated during diastole, early systole, and late systole. High-fidelity pressures were measured within and around the heart. Measurements were made at low volume [LoV; left ventricular end-diastolic pressure (LVEDP) ϭ 5-9 mmHg], high volume (HiV; LVEDP ϭ 16-19 mmHg), and HiV with the pericardium removed. Wave-intensity analysis demonstrated that, except during late systole, balloon inflation created forwardgoing PA compression waves that were transmitted directly through the heart without measurable delay; backward PA compression waves were transmitted in-series through the pulmonary vasculature and arrived after delays of 90 Ϯ 3 ms (HiV) and 103 Ϯ 5 ms (LoV; P Ͻ 0.05). Direct transmission was greater during diastole, and both direct and series transmission increased with volume loading. Pressure waves from the LA arrive in the PA by two distinct routes: rapidly and directly through the heart and delayed and in-series through the pulmonary vasculature. lung; arteries; hemodynamics; wave transmission WAVE TRANSMISSION through the heart is poorly understood. Among the clinical syndromes in which wave transmission could be an important, unappreciated factor are the stiff left atrium (LA) syndrome (6, 15) and the Bernheim syndrome (1,5,24). To study the transmission of waves generated in the LA, we created a system where a backward-going wave, originating from the LA, could be detected in the proximal pulmonary artery (PA; backward and forward are defined with respect to PA flow.) To create such a wave in a controlled fashion, we used an LA counterpulsation balloon. Pressure and velocity waveforms in the proximal PA were analyzed to evaluate the effects of LA pressure (P LA ) perturbations.Most commonly, pulsatile arterial phenomena have been characterized using Fourier analysis where the observed waveforms are decomposed into sinusoidal wave trains, and the results are expressed as amplitude and phase as a function of frequency (16,17). This frequency-domain analysis has provided much information. However, wave-intensity analysis where the observed waveforms are decomposed into a succession of infinitesimal wave fronts that are described by their amplitude and time (13,19) allows the interaction of forwardand backward-going waves and their relation to primary hemodynamic parameters (pressure, flow, etc.) to be studied directly. This method utilizes changes in pressure and velocity to evaluate the direction, intensity, and type of waves and has been used recently to study the systemic (18), pulmonary (8,11,22), and coronary circulations...

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“…First, coagulation necrosis and fibrosis in the atrium may lead to stiff atria, and a stiff atria may be the indirect mechanism of ventricular diastolic dysfunction. 27) Second, the ablation on the atrial side may also have an impact on the ventricular side. Ablation was performed on the areas where a small atrial great ventricular intracardiac electrogram was recorded.…”

Section: )mentioning

confidence: 99%

Sequential Evaluation of Left Ventricular Systolic and Diastolic Function After Radiofrequency Catheter Ablation

et al. 2004

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SUMMARYRadiofrequency (RF) catheter ablation has become standard therapy for many types of arrhythmias. RF energy may cause deterioration in left ventricular function by damaging the myocardium. The aim of the present study was to assess the changes in left ventricular function after catheter ablation using various echocardiographic parameters.Forty patients (22 women), aged 37 ± 14 years (range, 15-76 years), underwent catheter ablation for various tachycardias. Routine echocardiogaphic examination was done in all patients. Left ventricular systolic function was evaluated by the modified Simpson method and tissue Doppler. With regard to left ventricular diastolic function parameters, diastolic early (E) and late (A) transmitral filling velocities, deceleration time (DT), isovolumetric relaxation time (IVRT), and tissue Doppler parameters were assessed. All ventricular function parameters were assessed before, and 1 hour, 1 day, and 1 month after the catheter ablation procedure. To avoid any influence of heart rate on diastolic function parameters, the E/A ratio, DT, and IVRT were adjusted to heart rate (cE/A, cDT, cIVRT).No changes in left ventricular systolic function after the ablation were observed. After the ablation procedure (1 hour, 1 day, and 1 month) the cE/A ratio decreased from 1.42 ± 0.43 to 1.19 ± 0.40, 1.18 ± 0.40, and 1.30 ± 0.33 (P = 0.009), respectively. cDT increased from 210 ± 54 to 272 ± 64, 255 ± 60, 240 ± 64 (P = 0.001), respectively. Likewise cIVRT increased from 113 ± 22 to 133 ± 54, 123 ± 27, 117 ± 19 (P = 0.007), respectively. Significant changes were also observed concerning tissue Doppler parameters in assessing diastolic function.Although no significant changes were observed in systolic function after RF ablation, this procedure may have some detrimental effects on ventricular diastolic function parameters. (Jpn Heart J 2004; 45: 429-440)

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The clinical consequences of a stiff left atrium

Cited by 69 publications

References 8 publications

Left Atrial Remodeling and Function in Advanced Heart Failure With Preserved or Reduced Ejection Fraction

Left Atrial Remodeling and Function in Advanced Heart Failure With Preserved or Reduced Ejection Fraction

Direct and series transmission of left atrial pressure perturbations to the pulmonary artery: a study using wave-intensity analysis

Sequential Evaluation of Left Ventricular Systolic and Diastolic Function After Radiofrequency Catheter Ablation

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