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Inoue K, Kawakami H, Akazawa Y, Higashi H, Higaki T, Yamaguchi O. Echocardiographic Assessment of Atrial Function: From Basic Mechanics to Specific Cardiac Diseases. J Cardiovasc Dev Dis 2022; 9:jcdd9030068. [PMID: 35323616 PMCID: PMC8955277 DOI: 10.3390/jcdd9030068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023] Open
Abstract
The left and right atria serve as buffer chambers to control the flow of venous blood for ventricular filling. If an atrium is absent, blood does not flow effectively into the ventricle, leading to venous blood retention and low cardiac output. The importance of atrial function has become increasingly recognized, because left atrial (LA) function contributes to cardiac performance, and loss of LA function is associated with heart failure. LA volume change has been used for LA function assessment in experimental and clinical studies. In conjunction with LA pressure, the LA pressure–volume relationship provides a better understanding of LA mechanics. LA strain measurement by speckle tracking echocardiography was introduced to evaluate three components of LA function as a (booster) pump, reservoir and conduit. Furthermore, increasing evidence supports the theory that LA reservoir strain has prognostic utility in various cardiac diseases. In this review, we summarize LA contribution to maintain cardiac performance by evaluating LA function with echocardiography according to our experiences and previous reports. Furthermore, we discuss LA dysfunction in challenging cardiac diseases of cardiac amyloidosis and adult congenital heart disease.
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Affiliation(s)
- Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
- Correspondence: ; Tel.: +81-89-960-5303
| | - Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Yusuke Akazawa
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Takashi Higaki
- Department of Regional Pediatrics and Perinatology, Ehime University Graduate School of Medicine, Toon 791-029, Ehime, Japan;
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
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Nakao Y, Saito M, Inoue K, Higaki R, Yokomoto Y, Ogimoto A, Suzuki M, Kawakami H, Hiasa G, Okayama H, Ikeda S, Yamaguchi O. Cardiac amyloidosis screening using a relative apical sparing pattern in patients with left ventricular hypertrophy. Cardiovasc Ultrasound 2021; 19:30. [PMID: 34425846 PMCID: PMC8383373 DOI: 10.1186/s12947-021-00258-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/12/2021] [Indexed: 01/15/2023] Open
Abstract
Background Cardiac amyloidosis (CA) mimics left ventricular hypertrophy (LVH). It is treatable, but its prognosis is poor. A simple screening tool for CA would be valuable. CA is more precisely diagnosed with echocardiographic deformation parameters (e.g., relative apical sparing pattern [RASP]) than with conventional parameters. We aimed to 1) investigate incremental benefits of echocardiographic deformation parameters over established parameters for CA screening; 2) determine the resultant risk score for CA screening; and 3) externally validate the score in LVH patients. Methods We retrospectively studied 295 consecutive non-ischemic LVH patients who underwent detailed diagnostic tests. CA was diagnosed with biopsy or 99mTc-PYP scintigraphy. The base model comprised age (≥65 years [men], ≥70 years [women]), low voltage on the electrocardiogram, and posterior wall thickness ≥ 14 mm in reference to the literature. The incremental benefit of each binarized echocardiographic parameter over the base model was assessed using receiver operating characteristic curve analysis and comparisons of the area under the curve (AUC). Results Fifty-four (18%) patients had CA. RASP showed the most incremental benefit for CA screening over the base model. After conducting multiple logistic regression analysis for CA screening using four variables (RASP and base model components), a score was determined (range, 0–4 points). The score demonstrated adequate discrimination ability for CA (AUC = 0.86). This result was confirmed in another validation cohort (178 patients, AUC = 0.88). Conclusions We developed a score incorporating RASP for CA screening. This score is potentially useful in the risk stratification and management of LVH patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12947-021-00258-x.
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Affiliation(s)
- Yasuhisa Nakao
- Department of Cardiology, Kitaishikai Hospital, Higashiozu 1563-1, Ozu, Ehime, 795-8505, Japan.,Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Makoto Saito
- Department of Cardiology, Kitaishikai Hospital, Higashiozu 1563-1, Ozu, Ehime, 795-8505, Japan.
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Rieko Higaki
- Department of Cardiology, Kitaishikai Hospital, Higashiozu 1563-1, Ozu, Ehime, 795-8505, Japan
| | - Yuki Yokomoto
- Department of Cardiology, Uwajima City Hospital, Uwajima, Japan
| | | | - Moeko Suzuki
- Department of Cardiology, Ehime Prefectural Imabari Hospital, Imabari, Japan
| | - Hideo Kawakami
- Department of Cardiology, Ehime Prefectural Imabari Hospital, Imabari, Japan
| | - Go Hiasa
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Toon, Japan
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