Left ventricular diastolic dysfunction: identifying presence by left atrial function
Echo Research & Practice volume 5, pages 97–104 (2018)
Objective:The left atrium (LA) is exposed to left ventricular pressure during diastole. Applying the 2016 American Society of Echocardiography left ventricular diastolic function (LVDF) guidelines, this study aims to investigate whether left atrial ejection fraction (LAEF) and left atrial active emptying fraction (LAAEF) are markers of diastolic dysfunction (LVDD).
Methods: Retrospective cohort of consecutive patients (n = 124) who underwent transthoracic echocardiography were studied. Doppler peak velocities of passive (MV E) and active filling (MV A) were measured and ratio E/A calculated. Tissue Doppler imaging parameters of peak early (e′) of the septal and lateral mitral annulus were measured, and average E/e′ ratio (E/e′) was calculated. Tricuspid regurgitation velocity, left atrial maximum volume, left atrial minimum volume and LA volume pre-contraction were measured, allowing calculation of LAEF and LAAEF. Subjects were assigned LVDF categories.
Results: Binomial logistic regression model (X2(2) = 48.924, P < 0.01) determined that LAEF and LAAEF predicted diastolic dysfunction with sensitivity 85.5% and specificity 78%. ROC curves determined good diagnostic accuracy for LAEF and LAAEF to predict LVDD, AUC 0.826 and 0.861 respectively. Logistic regression model (X2(2) = 39.525, P < 0.01) predicted those patients with E/e′ ≥14 using LAEF and LAAEF with sensitivity 51.6% and specificity 92.4%. Moderate correlations were found between E/e′ and log derivatives of LAEF and LAAEF.
Conclusions: A decline in LAAEF and LAEF is associated with worsening LVDD.
Hoit BD. Left atrial size and function: role in prognosis. Journal of the American College of Cardiology 201463 493–505. (https://doi.org/10.1016/j.jacc.2013.10.055)
Prioli A, Marino P, Lanzoni L, Zardini P. Increasing degrees of left ventricular filling impairment modulate left atrial function in humans. American Journal of Cardiology 199882 756–761. (https://doi.org/10.1016/S0002-9149(98)00452-4)
Patel DA, Lavie CJ, Milani RV, Shah S, Gilliland Y. Clinical implications of left atrial enlargement: a review. Ochsner Journal 20099 191–196. (available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096293/)
Russo C, Jin Z, Homma S, Rundek T, Elkind MS, Sacco RL, Di Tullio MR. Left atrial minimum volume and reservoir function as correlates of left ventricular diastolic function: impact of left ventricular systolic function. Heart 201298 813–820. (https://doi.org/10.1136/heartjnl-2011-301388)
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography 201629 277–314. (https://doi.org/10.1016/j.echo.2016.01.011)
Manning WJ, Silverman DI, Katz SE, Douglas PS. Atrial ejection force: a noninvasive assessment of atrial systolic function. Journal of the American College of Cardiology 199322 221–225. (https://doi.org/10.1016/0735-1097(93)90838-R)
Dardas PS, Pitsis AA, Mezilis NE, Tsikaderis DD, Ninios VN, Boudoulas H. Left atrial function and work after surgical ventricular restoration in postmyocardial infarction heart failure. Journal of the American Society of Echocardiography 200821 841–847. (https://doi.org/10.1016/j.echo.2007.12.005)
Hsiao SH, Lin KL, Chiou KR. Comparison of left atrial volume parameters in detecting left ventricular diastolic dysfunction versus tissue Doppler recordings. American Journal of Cardiology 2012109 748–755. (https://doi.org/10.1016/j.amjcard.2011.10.040)
Vincent JL. Understanding cardiac output. Critical Care 200812 174. (https://doi.org/10.1186/cc6975)
Appleton CP, Galloway JM, Gonzalez MS, Gaballa M, Basnight MA. Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease. Additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction. Journal of the American College of Cardiology 199322 1972–1982. (https://doi.org/10.1016/0735-1097(93)90787-2)
Kataoka A, Funabashi N, Takahashi A, Yajima R, Takahashi M, Uehara M, Takaoka H, Saito M, Yamaguchi C, Lee K, et al. Quantitative evaluation of left atrial volumes and ejection fraction by 320-slice computed-tomography in comparison with three- and two-dimensional echocardiography: a single-center retrospective-study in 22 subjects. International Journal of Cardiology 2011153 47–54. (https://doi.org/10.1016/j.ijcard.2010.08.036)
Yoon YE, Kim HJ, Kim SA, Kim SH, Park JH, Park KH, Choi S, Kim MK, Kim HS, Cho GY. Left atrial mechanical function and stiffness in patients with paroxysmal atrial fibrillation. Journal of Cardiovascular Ultrasound 201220 140–145. (https://doi.org/10.4250/jcu.2012.20.3.140)
Anwar AM, Soliman OI, Nemes A, Geleijnse ML, ten Cate FJ. An integrated approach to determine left atrial volume, mass and function in hypertrophic cardiomyopathy by two-dimensional echocardiography. International Journal of Cardiovascular Imaging 200824 45–52. (https://doi.org/10.1007/s10554-007-9224-x)
Govindan M, Borgulya G, Kiotsekoglou A, Saha SK, Camm AJ. Prognostic value of left atrial expansion index and exercise-induced change in atrial natriuretic peptide as long-term predictors of atrial fibrillation recurrence. Europace 201214 1302–1310. (https://doi.org/10.1093/europace/eus088)
Wharton G, Steeds R, Allen J, Phillips H, Jones R, Kanagala P, Lloyd G, Masani N, Mathew T, Oxborough D, et al. A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the British Society of Echocardiography. Echo Research and Practice 20152 G9–G24. (https://doi.org/10.1530/ERP-14-0079)
Castello R, Pearson AC, Lenzen P, Labovitz AJ. Evaluation of pulmonary venous flow by transesophageal echocardiography in subjects with a normal heart: comparison with transthoracic echocardiography. Journal of the American College of Cardiology 199118 65–71. (https://doi.org/10.1016/S0735-1097(10)80219-0)
Scherr J, Jung P, Schuster T, Pollmer L, Eisele G, Goss F, Schneider J, Halle M. Left ventricular diastolic function is strongly correlated with active emptying of the left atrium: a novel analysis using three-dimensional echocardiography. Cardiovascular Ultrasound 201614 43. (https://doi.org/10.1186/s12947-016-0085-0)
Teo SG, Yang H, Chai P, Yeo TC. Impact of left ventricular diastolic dysfunction on left atrial volume and function: a volumetric analysis. European Journal of Echocardiography 201011 38–43. (https://doi.org/10.1093/ejechocard/jep153)
Rosca M, Lancellotti P, Popescu BA, Pierard LA. Left atrial function: pathophysiology, echocardiographic assessment, and clinical applications. Heart 201197 1982–1989. (https://doi.org/10.1136/heartjnl-2011-300069)
Ginghina C, Beladan CC, Iancu M, Calin A, Popescu BA. Respiratory maneuvers in echocardiography: a review of clinical applications. Cardiovascular Ultrasound 20097 42. (https://doi.org/10.1186/1476-7120-7-42)
This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
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Worley, E., Rana, B., Williams, L. et al. Left ventricular diastolic dysfunction: identifying presence by left atrial function. Echo Res Pract 5, 97–104 (2018). https://doi.org/10.1530/ERP-18-0013