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Fragata CDS, Matsumoto AY, Ramires FJA, Fernandes F, Buck PDC, Salemi VMC, Nastari L, Mady C, Ianni BM. Left Atrial Function in Patients with Chronic Chagasic Cardiomyopathy. Arq Bras Cardiol 2015; 105:28-36. [PMID: 25993486 PMCID: PMC4523285 DOI: 10.5935/abc.20150045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 12/23/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Chagas disease is a cause of dilated cardiomyopathy, and information about left atrial (LA) function in this disease still lacks. OBJECTIVE To assess the different LA functions (reservoir, conduit and pump functions) and their correlation with the echocardiographic parameters of left ventricular (LV) systolic and diastolic functions. METHODS 10 control subjects (CG), and patients with Chagas disease as follows: 26 with the indeterminate form (GI); 30 with ECG alterations (GII); and 19 with LV dysfunction (GIII). All patients underwent M-mode and two-dimensional echocardiography, pulsed-wave Doppler and tissue Doppler imaging. RESULTS Reservoir function (Total Emptying Fraction: TEF): (p <0.0001), lower in GIII as compared to CG (p = 0.003), GI (p <0.001) and GII (p <0.001). Conduit function (Passive Emptying Fraction: PEF): (p = 0.004), lower in GIII (GIII and CG, p = 0.06; GI and GII, p = 0.06; and GII and GIII, p = 0.07). Pump function (Active Emptying Fraction: AEF): (p = 0.0001), lower in GIII as compared to CG (p = 0.05), GI (p<0.0001) and GII (p = 0.002). There was a negative correlation of E/e' (average) with the reservoir and pump functions (TEF and AEF), and a positive correlation of e' (average) with s' wave (both septal and lateral walls) and the reservoir, conduit and pump LA functions. CONCLUSION An impairment of LA functions in Chagas cardiomyopathy was observed.
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Affiliation(s)
| | - Afonso Y Matsumoto
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR
| | - Felix J A Ramires
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR
| | - Fabio Fernandes
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR
| | - Paula de Cássia Buck
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR
| | - Vera Maria C Salemi
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR
| | - Luciano Nastari
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR
| | - Charles Mady
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR
| | - Barbara Maria Ianni
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR
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Tenekecioglu E, Agca FV, Ozluk OA, Karaagac K, Demir S, Peker T, Kuzeytemiz M, Senturk M, Yilmaz M. Disturbed Left Atrial Function is Associated with Paroxysmal Atrial Fibrillation in Hypertension. Arq Bras Cardiol 2014; 102:253-62. [PMID: 24676227 PMCID: PMC3987319 DOI: 10.5935/abc.20140009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 10/08/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hypertension is the most prevalent and modifiable risk factor for atrial fibrillation. The pressure overload in the left atrium induces pathophysiological changes leading to alterations in contractile function and electrical properties. OBJECTIVE In this study our aim was to assess left atrial function in hypertensive patients to determine the association between left atrial function with paroxysmal atrial fibrillation (PAF). METHOD We studied 57 hypertensive patients (age: 53 ± 4 years; left ventricular ejection fraction: 76 ± 6.7%), including 30 consecutive patients with PAF and 30 age-matched control subjects. Left atrial (LA) volumes were measured using the modified Simpson's biplane method. Three types of LA volume were determined: maximal LA(LAVmax), preatrial contraction LA(LAVpreA) and minimal LA volume(LAVmin). LA emptying functions were calculated. LA total emptying volume = LAVmax-LAVmin and the LA total EF = (LAVmax-LAVmin )/LAVmax, LA passive emptying volume = LAVmax- LAVpreA and the LA passive EF = (LAVmax-LAVpreA)/LAVmax, LA active emptying volume = LAVpreA-LAVmin and LA active EF = (LAVpreA-LAVmin )/LAVpreA. RESULTS The hypertensive period is longer in hypertensive group with PAF. LAVmax significantly increased in hypertensive group with PAF when compared to hypertensive group without PAF (p=0.010). LAAEF was significantly decreased in hypertensive group with PAF as compared to hypertensive group without PAF (p=0.020). A' was decreased in the hypertensive group with PAF when compared to those without PAF (p = 0.044). CONCLUSION Increased LA volume and impaired LA active emptying function was associated with PAF in untreated hypertensive patients. Longer hypertensive period is associated with PAF.
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Affiliation(s)
- Erhan Tenekecioglu
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Resarch Hospital, Bursa, Turkey
| | - Fahriye Vatansever Agca
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Resarch Hospital, Bursa, Turkey
| | - Ozlem Arican Ozluk
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Resarch Hospital, Bursa, Turkey
| | - Kemal Karaagac
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Resarch Hospital, Bursa, Turkey
| | | | - Tezcan Peker
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Resarch Hospital, Bursa, Turkey
| | - Mustafa Kuzeytemiz
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Resarch Hospital, Bursa, Turkey
| | - Muhammed Senturk
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Resarch Hospital, Bursa, Turkey
| | - Mustafa Yilmaz
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Resarch Hospital, Bursa, Turkey
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Khan UA, de Simone G, Hill J, Tighe DA, Aurigemma GP. Depressed atrial function in diastolic dysfunction: a speckle tracking imaging study. Echocardiography 2012; 30:309-16. [PMID: 23237327 DOI: 10.1111/echo.12043] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Two-dimensional speckle tracking imaging (STI) has recently been applied to the study of left atrial (LA) reservoir function. We utilized STI to analyze LA function in diastolic dysfunction (DD), hypothesizing that LA strain abnormality is part of the pathogenesis of diastolic dysfunction. METHODS We applied STI to 50 patients with Grade 1-2 DD, comparing these results to 100 normal controls. Complete Doppler analysis of filling was made using peak E, peak A and tissue Doppler e' velocities; E/e' was used as a surrogate for LA pressure and LA stiffness index was calculated. RESULTS In analysis of covariance, adjusting for age and gender, compared with controls, DD patients had higher E/e', greater LA volume and greater LA stiffness, but lower E/A ratio and global LA strain. LA strain appears to be inversely related to LA volume, but not to other indices of LV diastolic function. In subgroup analysis, LA strain was significantly lower, and stiffness significantly higher in DD, even after correction for differences in LA volume and E/A ratio. Analysis of ROC curves suggests that abnormal LA strain is a better marker for diastolic dysfunction than LA enlargement. CONCLUSION LA strain by STI is significantly reduced in early diastolic dysfunction and is related to higher LA stiffness and LA size. Reduction in LA strain is partially independent of LA volume; accordingly we hypothesize that reduced atrial strain indicates impaired atrial distensibility.
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Affiliation(s)
- Umar A Khan
- Division of Cardiovascular Disease, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
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Role of plasma aldosterone concentration in regression of left-ventricular mass following antihypertensive medication. J Hypertens 2011; 29:357-63. [PMID: 21052021 DOI: 10.1097/hjh.0b013e32834103d4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Aldosterone is known to bring about damage to various organs; however, it is unclear how important the changes in plasma aldosterone concentration (PAC) are as contributors to regression of left-ventricular (LV) mass in hypertensive patients following long-term treatment with calcium channel blockers (CCBs) or angiotensin II receptor blockers (ARBs). OBJECTIVE To assess the importance of changes in PAC during antihypertensive treatment. METHODS Forty-four untreated hypertensive patients were randomly assigned to either CCB (amlodipine) group or ARB (losartan) group. In addition to PAC measurements LV geometry was echocardiographically assessed with LV mass index (LVMI) and relative wall thickness (RWT) before and 6 and 12 months after treatment. RESULTS Reduction of systolic blood pressure (SBP) in 12 months was greater in the CCB group than in the ARB group (-19 ± 8 vs. -11 ± 15%, P < 0.05 as percentage reduction from the values before treatment). PAC decreased in 12 months in the ARB group but not in the CCB group (-31 ± 31 vs. 17 ± 53%, P < 0.01 as percentage reduction from the values before treatment). Larger percentage drop in PAC was associated with larger percentage reduction of LVMI (r = 0.45, P < 0.01 for all). Multiple step-wise regression analysis showed that the percentage reduction of LVMI is related to the percentage changes in SBP and the percentage changes in PAC (r = 0.46, P < 0.01). CONCLUSION Regression of LV mass was the larger in patients with the greater decrease in PAC associated with antihypertensive medication regardless of CCB or ARB. Changes in PAC and SBP may be key determinants of regression of LV mass in hypertensive patients regardless of the medication selected.
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Gong HP, Zhang W, Li L, Tan HW, Ma ZY, Zhong XZ, Wang ZH, Song T, Zhang Y, Zhong M. Possible beneficial effect of olmesartan medoxomil on left atrial function in patients with hypertension : noninvasive assessment by acoustic quantification. Clin Drug Investig 2008; 28:241-9. [PMID: 18345714 DOI: 10.2165/00044011-200828040-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Hypertension alters the diastolic properties of the left ventricle and results in deterioration in the structure and function of the left atrium. We aimed to evaluate whether olmesartan medoxomil has an effect on left atrial function in hypertensive patients. METHODS Fifty hypertensive patients and 20 controls were included in the study. Hypertensive patients were treated with olmesartan medoxomil for 8 weeks. Before and after treatment, study participants were examined by acoustic quantification and tissue Doppler imaging. Left atrial reservoir function was assessed by end-diastolic volume (EDV), end-systolic volume (ESV), reservoir volume (RV) and peak filling rate (PFR). Left atrial booster pump function was assessed by atrial emptying volume (AEV), atrial emptying fraction (AEF) and peak atrial emptying rate (PAER). Left atrial conduit function was assessed by rapid emptying volume (REV), rapid emptying fraction (REF), REV/AEV ratio, and the ratio of peak rapid emptying rate and PAER (PRER/PAER). RESULTS Atrial RV and PFR were significantly increased in hypertensive subjects (48.30 +/- 19.28 mL vs 34.35 +/- 14.26 mL, p < 0.001; 267.26 +/- 126.52 mL/s vs 206.81 +/- 107.17 mL/s, p < 0.05) compared with controls, while the REV/AEV ratio was decreased in hypertensive patients compared with controls (2.86 +/- 0.85 vs 3.69 +/- 2.13, p < 0.001). After therapy with olmesartan medoxomil, atrial RV (48.30 +/- 19.28 mL vs 40.50 +/- 17.59 mL) and PFR decreased (267.26 +/- 126.52 mL/s vs 220.40 +/- 108.56 mL/s, p < 0.05) and the REV/AEV ratio increased (2.86 +/- 0.85 vs 3.14 +/- 0.43, p < 0.05) in hypertensive patients. CONCLUSION Our novel findings indicate that left atrial function is impaired in hypertensive patients, and that olmesartan medoxomil can improve left atrial function in this context. Our study also showed that acoustic quantification is useful for non-invasive evaluation of the benefits of treatment on left atrial function.
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Affiliation(s)
- Hui-Ping Gong
- Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education and Chinese Ministry of Health, QiLu Hospital, Shandong University, Jinan, China
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CUI Q, WANG H, ZHANG W, WANG H, SUN X, ZHANG Y, YANG H. Enhanced Left Atrial Reservoir, Increased Conduit, and Weakened Booster Pump Function in Hypertensive Patients with Paroxysmal Atrial Fibrillation. Hypertens Res 2008; 31:395-400. [DOI: 10.1291/hypres.31.395] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kokubu N, Yuda S, Tsuchihashi K, Hashimoto A, Nakata T, Miura T, Ura N, Nagao K, Tsuzuki M, Wakabayashi C, Shimamoto K. Noninvasive assessment of left atrial function by strain rate imaging in patients with hypertension: a possible beneficial effect of renin-angiotensin system inhibition on left atrial function. Hypertens Res 2007; 30:13-21. [PMID: 17460367 DOI: 10.1291/hypres.30.13] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Renin-angiotensin system (RAS) inhibitors are likely to reduce the development of atrial fibrillation by preventing atrial fibrosis. Strain rate (SR) imaging is a novel echocardiographic technique to quantify left atrial (LA) function. However, it has not been determined whether SR imaging is applicable for detection of LA dysfunction in hypertensive (HT) patients. We used SR imaging to assess alteration in LA function in HT patients and its modification by RAS inhibitors. SR imaging was performed in 80 HT patients and 50 age-matched normotensive (NT) subjects. HT patients were divided into two groups according to left ventricular hypertrophy (LVH) and LA dilatation. Peak SR was measured at each LA segment (septal, lateral, posterior, anterior, and inferior) and mean peak systolic SR (SR-LAs) was calculated by averaging data in each segment. Mean SR-LAs levels in the dilated LA group (1.97+/-0.45 s(-1), n=25) and non-dilated LA group (2.15+/-0.57 s(-1), n=55) were significantly (p<0.05) lower than that in NT subjects (2.53+/-0.71 s(-1)). Irrespective of the presence or absence of LVH, mean SR-LAs in HT patients was lower than that in NT subjects. When RAS inhibitors were used, the mean SR-LAs level in the non-dilated LA group was equivalent to that in NT subjects. In HT patients, mean SR-LAs, an index of LA reservoir function, decreases before development of LA enlargement and LVH. Treatment with RAS inhibitors appears to preserve LA reservoir function in HT patients without dilated LA. SR imaging can detect LA dysfunction in HT patients and is useful for evaluation of the therapeutic benefit on LA reservoir function.
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Affiliation(s)
- Nobuaki Kokubu
- Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Japan
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Aydin M, Ozeren A, Bilge M, Dursun A, Cam F, Elbey MA. Effects of dipper and non-dipper status of essential hypertension on left atrial mechanical functions. Int J Cardiol 2004; 96:419-24. [PMID: 15301896 DOI: 10.1016/j.ijcard.2003.08.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2003] [Accepted: 08/11/2003] [Indexed: 11/15/2022]
Abstract
AIM This study was designed in order to investigate the effects of dipper and non-dipper status of hypertension on left atrial mechanical (reservoir, conduit and booster pump) functions with left atrial volume measurements by means of two-dimensional echocardiography in untreated systemic hypertensive patients. METHOD A total of 27 untreated dipper hypertensive patients, group I (15 female, 12 male, mean age 57+/-12 years); 23 untreated non-dipper hypertensive patients, group II (12 female, 11 male, mean age: 53+/-18 years); and 25 voluntary healthy individuals, group III (13 female, 12 male, mean age 53+/-10 years) were included into the study. Twenty-four hour blood pressure (BP) measurement was performed by the cuff-oscillometric method to evaluate the nocturnal decrease of BP. The patients whose night time mean blood pressure measurements were found 10% or more lower compared to mean day time measurements were classified as dipper hypertensive patients and the ones with a decrease of less than 10% were classified as non-dipper hypertensive patients. Left atrial (LA) volumes were measured echocardiographically according to biplane area-length method in apical four-chamber and two-chamber views. LA maximal volume (V(max)) was recorded at the onset of mitral opening, LA minimal volume (V(min)) was recorded at the onset of mitral closure and LA presystolic volume (V(p)) was recorded at the beginning of the atrial systole (p wave on ECG). All volume measurements were corrected to body surface area, and following LA emptying functions parameters were calculated: LA passive emptying volume (LAPEV)=V(max)-V(p), LA passive emptying fraction (LAPEF)=LAPEV/V(max), Conduit volume (CV)=left ventricular output volume-(V(max)-V(min)), LA active emptying volume (LAAEV)=V(p)-V(min), LA active emptying fraction (LAAEF)=LAAEV/V(p), LA total emptying volume (LATEV)=V(max)-V(min), LA total emptying fraction (LATEF)=LATEV/V(max). RESULTS LA volume indexes, V(max), V(min), and V(p), were significantly increased in the hypertensive subgroups (groups I and II) than in controls (p<0.001, p<0.001, p<0.001, respectively), but no significant difference was found in the V(p) values between group I and group II. V(max) and V(min) were larger in non-dipper hypertensive group than in dipper hypertensive group (p<0.05 and p<0.05, respectively). LAPEV and LAPEF were observed to be significantly reduced in both dipper and non-dipper hypertensives than in control (p<0.001 and p<0.05, respectively), and this difference was more obvious in non-dipper than dipper cases (p<0.001). Conduit volume was significantly lower in hypertensive groups than controls (p<0.05). LA active emptying volume (p<0.001) and LAA active emptying fraction (p<0.001) were significantly greater in hypertensive cases than in controls. Furthermore, LA active emptying volume in non-dipper hypertensive subjects was significantly greater than dipper hypertensive cases (p<0.05). Left atrial total emptying volume and left atrial total emptying fraction in both hypertensive groups were similar to control (p>0.05). CONCLUSIONS Atrial reservoir and booster pump functions increase in hypertensive patients, but this result is more prominent in non-dipper hypertensives than in dipper hypertensive patients.
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Affiliation(s)
- Mustafa Aydin
- Department of Cardiology, Medical Faculty, Karaelmas University, Kozlu, 67600 Zonguldak, Turkey.
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Spencer KT, Mor-Avi V, Gorcsan J, DeMaria AN, Kimball TR, Monaghan MJ, Perez JE, Weinert L, Bednarz J, Edelman K, Kwan OL, Glascock B, Hancock J, Baumann C, Lang RM. Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study. Heart 2001; 85:272-7. [PMID: 11179264 PMCID: PMC1729654 DOI: 10.1136/heart.85.3.272] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the feasibility of measuring left atrial (LA) function with acoustic quantification (AQ) and then assess the effects of age and sex on LA reservoir, conduit, and booster pump function. PATIENTS AND SETTING 165 subjects without cardiovascular disease, 3-79 years old, were enrolled by six tertiary hospital centres. INTERVENTIONS Continuous LA AQ area data were acquired and signal averaged to form composite waveforms which were analysed off-line. MAIN OUTCOME MEASURES Parameters of LA performance according to age and sex. RESULTS Signal averaged LA waveforms were sufficiently stable and detailed to allow automated analysis in all cases. An age related increase in LA area was noted. LA reservoir function did not vary with age or sex. All parameters of LA passive and active emptying revealed a significant age dependency. Overall, the passive emptying phase accounted for 66% of total LA emptying ranging from 76% in the youngest to 44% in the oldest decade. LA contraction accounted for 34% of atrial emptying in all subjects combined with the older subjects being more dependent on atrial booster pump function. When adjusted for atrial size, there were no sex related differences in LA function. CONCLUSIONS LA reservoir, conduit, and booster pump function can be assessed with automated analysis of signal averaged LA area waveforms. As LA performance varies with age, establishment of normal values should enhance the evaluation of pathologic states in which LA function is important.
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Affiliation(s)
- K T Spencer
- University of Chicago, Chicago, Illinois, USA.
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