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Impact of Left Ventricular Diastolic Property on Left Atrial Function from Simultaneous Left Atrial and Ventricular Three-Dimensional Echocardiographic Volume Measurement

Published:February 28, 2017DOI:https://doi.org/10.1016/j.amjcard.2017.02.002
      Simultaneous left atrial (LA) and left ventricular (LV) 3-dimensional (3D) echocardiographic volume measurements enable the quantifying of precise LA function, by virtue of their independence on any geometric assumption and capability of measurement for net LA conduit volume. We sought to elucidate the impact of conventional Doppler LV diastolic property on LA volume and function derived from this method. Our study subjects consisted of 381 patients who underwent 3D echocardiography. From LA time-volume curve, maximum and minimum volume index (VI) and VI before atrial contraction (LAVIpre-c) were determined; subsequently, active emptying volume was calculated as LAVIpre-c − minimum LAVI. From LA and LV volume measurement, conduit volume was calculated as LV stroke VI − (maximum LAVI − minimum LAVI). LA volume increased depending on the severity of diastolic dysfunction. Compared with patients with normal diastolic function, LA booster pump function, as the contribution of active emptying volume to LV filling, was higher in those with mild diastolic dysfunction. Additionally, it gradually decreased as diastolic dysfunction was advanced from mild to moderate and moderate to severe degree (23.2 ± 15.5%, 29.5 ± 15.1%, 25.1 ± 16.2%, 14.9 ± 14.1%, respectively; p <0.001). Contrarily, conduit contribution was significantly higher in patients with severe diastolic dysfunction than in those with mild diastolic dysfunction; furthermore, conduit function tended to increase, reciprocally to booster pump function, as diastolic dysfunction grade was advanced (39.1 ± 28.8%, 36.8 ± 26.2%, 42.7 ± 25.6%, 52.9 ± 26.2%, respectively; p = 0.034). In conclusion, simultaneous LA and LV volumetric analyses through 3D echocardiography clearly demonstrate the characteristic LA functional alterations following LA dilation caused by LV diastolic dysfunction.
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      References

        • Gupta S.
        • Matulevicius S.A.
        • Ayers C.R.
        • Berry J.D.
        • Patel P.C.
        • Markham D.W.
        • Levine B.D.
        • Chin K.M.
        • de Lemos J.A.
        • Peshock R.M.
        • Drazner M.H.
        Left atrial structure and function and clinical outcomes in the general population.
        Eur Heart J. 2013; 34: 278-285
        • Kurt M.
        • Wang J.
        • Torre-Amione G.
        • Nagueh S.F.
        Left atrial function in diastolic heart failure.
        Circ Cardiovasc Imaging. 2009; 2: 10-15
        • Matsuda Y.
        • Toma Y.
        • Ogawa H.
        • Matsuzaki M.
        • Katayama K.
        • Fujii T.
        • Yoshino F.
        • Moritani K.
        • Kumada T.
        • Kusukawa R.
        Importance of left atrial function in patients with myocardial infarction.
        Circulation. 1983; 67: 566-571
        • Tsang T.S.
        • Barnes M.E.
        • Gersh B.J.
        • Bailey K.R.
        • Seward J.B.
        Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden.
        Am J Cardiol. 2002; 90: 1284-1289
        • Pritchett A.M.
        • Mahoney D.W.
        • Jacobsen S.J.
        • Rodeheffer R.J.
        • Karon B.L.
        • Redfield M.M.
        Diastolic dysfunction and left atrial volume: a population-based study.
        J Am Coll Cardiol. 2005; 45: 87-92
        • Moller J.E.
        • Hillis G.S.
        • Oh J.K.
        • Seward J.B.
        • Reeder G.S.
        • Wright R.S.
        • Park S.W.
        • Bailey K.R.
        • Pellikka P.A.
        Left atrial volume: a powerful predictor of survival after acute myocardial infarction.
        Circulation. 2003; 107: 2207-2212
        • Lang R.M.
        • Badano L.P.
        • Mor-Avi V.
        • Afilalo J.
        • Armstrong A.
        • Ernande L.
        • Flachskampf F.A.
        • Foster E.
        • Goldstein S.A.
        • Kuznetsova T.
        • Lancellotti P.
        • Muraru D.
        • Picard M.H.
        • Rietzschel E.R.
        • Rudski L.
        • Spencer K.T.
        • Tsang W.
        • Voigt J.U.
        Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        J Am Soc Echocardiogr. 2015; 28: 1-39
        • Mor-Avi V.
        • Yodwut C.
        • Jenkins C.
        • Kuhl H.
        • Nesser H.J.
        • Marwick T.H.
        • Franke A.
        • Weinert L.
        • Niel J.
        • Steringer-Mascherbauer R.
        • Freed B.H.
        • Sugeng L.
        • Lang R.M.
        Real-time 3D echocardiographic quantification of left atrial volume: multicenter study for validation with CMR.
        JACC Cardiovasc Imaging. 2012; 5: 769-777
        • Badano L.P.
        • Miglioranza M.H.
        • Mihaila S.
        • Peluso D.
        • Xhaxho J.
        • Marra M.P.
        • Cucchini U.
        • Soriani N.
        • Iliceto S.
        • Muraru D.
        Left atrial volumes and function by three-dimensional echocardiography: reference values, accuracy, reproducibility, and comparison with two-dimensional echocardiographic measurements.
        Circ Cardiovasc Imaging. 2016; 9: e004229
        • Sugeng L.
        • Weinert L.
        • Lang R.M.
        Left ventricular assessment using real time three dimensional echocardiography.
        Heart. 2003; 89: iii29-iii36
        • Saraiva R.M.
        • Yamano T.
        • Matsumura Y.
        • Takasaki K.
        • Toyono M.
        • Agler D.A.
        • Greenberg N.
        • Thomas J.D.
        • Shiota T.
        Left atrial function assessed by real-time 3-dimensional echocardiography is related to right ventricular systolic pressure in chronic mitral regurgitation.
        Am Heart J. 2009; 158: 309-316
        • Nappo R.
        • Degiovanni A.
        • Bolzani V.
        • Sartori C.
        • Di Giovine G.
        • Cerini P.
        • Fossaceca R.
        • Kovacs S.J.
        • Marino P.N.
        Quantitative assessment of atrial conduit function: a new index of diastolic dysfunction.
        Clin Res Cardiol. 2016; 105: 17-28
        • Bowman A.W.
        • Kovacs S.J.
        Left atrial conduit volume is generated by deviation from the constant-volume state of the left heart: a combined MRI-echocardiographic study.
        Am J Physiol Heart Circ Physiol. 2004; 286: H2416-H2424
        • Germans T.
        • Gotte M.J.
        • Nijveldt R.
        • Spreeuwenberg M.D.
        • Beek A.M.
        • Bronzwaer J.G.
        • Visser C.A.
        • Paulus W.J.
        • van Rossum A.C.
        Effects of aging on left atrioventricular coupling and left ventricular filling assessed using cardiac magnetic resonance imaging in healthy subjects.
        Am J Cardiol. 2007; 100: 122-127
        • Prioli A.
        • Marino P.
        • Lanzoni L.
        • Zardini P.
        Increasing degrees of left ventricular filling impairment modulate left atrial function in humans.
        Am J Cardiol. 1998; 82: 756-761
        • Otani K.
        • Takeuchi M.
        • Kaku K.
        • Haruki N.
        • Yoshitani H.
        • Tamura M.
        • Abe H.
        • Okazaki M.
        • Ota T.
        • Lang R.M.
        • Otsuji Y.
        Impact of diastolic dysfunction grade on left atrial mechanics assessed by two-dimensional speckle tracking echocardiography.
        J Am Soc Echocardiogr. 2010; 23: 961-967
        • Hoit B.D.
        • Shao Y.
        • Gabel M.
        • Walsh R.A.
        In vivo assessment of left atrial contractile performance in normal and pathological conditions using a time-varying elastance model.
        Circulation. 1994; 89: 1829-1838
        • Redfield M.M.
        • Jacobsen S.J.
        • Burnett Jr., J.C.
        • Mahoney D.W.
        • Bailey K.R.
        • Rodeheffer R.J.
        Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic.
        JAMA. 2003; 289: 194-202
        • Nagueh S.F.
        • Appleton C.P.
        • Gillebert T.C.
        • Marino P.N.
        • Oh J.K.
        • Smiseth O.A.
        • Waggoner A.D.
        • Flachskampf F.A.
        • Pellikka P.A.
        • Evangelista A.
        Recommendations for the evaluation of left ventricular diastolic function by echocardiography.
        J Am Soc Echocardiogr. 2009; 22: 107-133
        • Spencer K.T.
        • Mor-Avi V.
        • Gorcsan 3rd, J.
        • DeMaria A.N.
        • Kimball T.R.
        • Monaghan M.J.
        • Perez J.E.
        • Weinert L.
        • Bednarz J.
        • Edelman K.
        • Kwan O.L.
        • Glascock B.
        • Hancock J.
        • Baumann C.
        • Lang R.M.
        Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study.
        Heart. 2001; 85: 272-277
        • Russo C.
        • Jin Z.
        • Homma S.
        • Rundek T.
        • Elkind M.S.
        • Sacco R.L.
        • Di Tullio M.R.
        Left atrial minimum volume and reservoir function as correlates of left ventricular diastolic function: impact of left ventricular systolic function.
        Heart. 2012; 98: 813-820
        • Marino P.
        Correct estimation of conduit function from left atrial volume curve assessment only is unlikely.
        J Am Soc Echocardiogr. 2010; 23 (author reply 1333–1334): 1333
        • Narayanan A.
        • Aurigemma G.P.
        • Chinali M.
        • Hill J.C.
        • Meyer T.E.
        • Tighe D.A.
        Cardiac mechanics in mild hypertensive heart disease: a speckle-strain imaging study.
        Circ Cardiovasc Imaging. 2009; 2: 382-390
        • Galderisi M.
        • Lomoriello V.S.
        • Santoro A.
        • Esposito R.
        • Olibet M.
        • Raia R.
        • Di Minno M.N.
        • Guerra G.
        • Mele D.
        • Lombardi G.
        Differences of myocardial systolic deformation and correlates of diastolic function in competitive rowers and young hypertensives: a speckle-tracking echocardiography study.
        J Am Soc Echocardiogr. 2010; 23: 1190-1198
        • Nagueh S.F.
        • Smiseth O.A.
        • Appleton C.P.
        • Byrd 3rd, B.F.
        • Dokainish H.
        • Edvardsen T.
        • Flachskampf F.A.
        • Gillebert T.C.
        • Klein A.L.
        • Lancellotti P.
        • Marino P.
        • Oh J.K.
        • Popescu B.A.
        • Waggoner A.D.
        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.
        J Am Soc Echocardiogr. 2016; 29: 277-314
        • Barbier P.
        • Solomon S.B.
        • Schiller N.B.
        • Glantz S.A.
        Left atrial relaxation and left ventricular systolic function determine left atrial reservoir function.
        Circulation. 1999; 100: 427-436