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PubMed1998

Severely reduced left atrial appendage function: a cause of embolic stroke in patients in sinus rhythm?

Recently, attention has been focused on transesophageal echocardiographic detection of left atrial appendage function to assess of risk of thrombus formation because of potential benefit of anticoagulation therapy. However, most of these studies have been conducted in patients with atrial fibrillation or mitral valve disease. In this article we review cases of 2 patients without valvular disease who had embolic stroke in sinus rhythm. Transesophageal echocardiography revealed thrombi in the left atrial appendage in both patients. The left atrial appendage function in these patients was compared with that in patients with chronic atrial fibrillation and a control group in sinus rhythm. Left atrial appendage function in the patients with stroke and sinus rhythm was significantly lower than that of patients in the control group in sinus rhythm (P < .001) and was similar to the appendage function in patients with chronic atrial fibrillation. These observations provide further evidence that the finding of reduced left atrial appendage function can be a cause of stroke in patients with sinus rhythm even in the absence of mitral valve disease. Reduced left atrial appendage function may identify patients with unexplained stroke who should receive anticoagulation therapy even in the absence of detectable appendage thrombi.

Adult↗
PubMed2004

P wave dispersion and left atrial appendage function for predicting recurrence after conversion of atrial fibrillation and relation of p wave dispersion to appendage function.

BACKGROUND: We investigated P wave dispersion and left atrial appendage (LAA) function for predicting atrial fibrillation (AF) relapse, and the relationship between P wave dispersion and LAA function. METHODS: Sixty-four consecutive patients with AF lasting </=3 months were evaluated to predict the recurrence after successful cardioversion. P wave duration and dispersion were measured in a 12-lead electrocardiograph (ECG). The size and function of the left atrium (LA) and LAA were assessed by transthoracic and transesophageal echocardiography. RESULTS: After 6 months, 28 patients experienced recurrent AF and 36 remained in sinus rhythm. There was no difference between patients with and without recurrence in gender, age, underlying heart disease, AF patterns, left ventricular function, and maximum LAA area. AF duration >/=5 days, LA size >/=45 mm, maximum P wave duration >/=112 ms, P wave dispersion >/=47 ms, spontaneous echo contrast, minimum LAA area >/=166 mm(2), and LAA emptying velocity <36 cm/sec were univariate predictors of recurrence (each P < 0.05). By multivariate analysis, LA size (P = 0.02), P wave dispersion (P < 0.001), and LAA emptying flow (P = 0.01) identified patients with recurrent AF. Their positive predictive values were 91, 97, and 72%, respectively. CONCLUSION: The increased P wave dispersion in addition to the dilated LA and the depressed LAA emptying flow can identify patients at risk of recurrent AF after cardioversion.

Aged↗
PubMed2000

[Restoration of the left atrial mechanical function after successful electrical cardioversion].

Some papers indicate that restoration of the left atrial mechanical function (LAMF) can be delayed to even 7 days after successful electrical cardioversion. The goals of the paper include the estimation of delay in restoration of LAMF and factors that influence it. 75 patients (53 males and 22 females, av. age 56.5 +/- 10.8) after elective electrical cardioversion underwent daily echocardiography to determine LAMF, taking A/E ratio > 1/3 as a criterion. The patients were divided into 2 subgroups: G1--with restoration of LAMF < 24 h after cardioversion and G2: the remaining ones. The analysed parameters were: left atrium diameter, rheumatic valvular disease, duration of atrial fibrillation, global and segmental contractility disorders. The data were analysed with ANOVA. The restoration of LAMF < 24 h was found in 53 patients; on the 2nd day in 6 patients, on the 3rd-8th day in 14 patients. In 2 patients no LAMF could be found on the 14th day after cardioversion. Failure to restore LAMF on the cardioversion day was related to: left atrium enlargement, rheumatic valvular disease, duration of atrial fibrillation > 14 days and contractility disorders.

Atrial Fibrillation↗
PubMed1996

[Left atrial contractility function in hypertension].

UNLABELLED: The purpose of this study was the assessment of the left systolic atrial function (LSAF) in 45 hypertensive subjects (HS) with left ventricular hypertrophy (LVH). (LV mass index) (LVMI) (> 134 g/m2 for men, > 110 g/m2 for women) and in 32 normal subjects (NS). The both groups were matched for age, body surface, heart rate and LV fractional shortening. Left atrial volume (LAV) was calculated by the formula: LAV = 8 A1 x A2/3 pi l in which A1 is the area of the four-chamber view, A2 is the area of the two-chamber view and L is common length in the two views. The atrial function contractility was evaluated by the following parameters: 1. LA stroke volume (LASV) = LAV - LAMV where LAV is the volume before atrial systole and LAMV is the LA minimal volume. 2. LA ejection fraction (LAEF) = LASV/LAV. 3. Atrial ejection force (AEF) = peak A/MOA in which peak A wave is the maximal late diastolic velocity and MOA is the mitral orifice area. 4. Atrial transport (AT) = A/M in which M area is under the mitral velocity curve and A-area under the late diastolic velocity curved assessed by Doppler echo. [table: see text] Thus all above parameters are significantly increased in HS. In HS, LASV is correlated to LAV (r = 0.84; p < 0.001) and to LVMI (r = 0.32; p < 0.05). LAEF is correlated to peak A (r = 0.90; p < 0.001) and LVMI (r = 0.34; p < 0.05). CONCLUSIONS: In HS with LVH in comparison with N, the increase of the LA contractility is considered to be urged by the increase of LAV (Frank-Starling's law). These data could be explained by the less distensibility of LV chamber in relation to LVH.

Adolescent↗
PubMed2005

Left atrial mechanical functions in pre-eclampsia.

AIM: To assess the effect of short-term pressure overload on left atrial (LA) mechanical function in pre-eclampsia. METHODS: Twenty women with pre-eclampsia and 17 age-matched healthy pregnant women were included. LA volumes were measured echocardiographically at the time of mitral valve opening (Vmax), onset of atrial systole (p-wave at the electrocardiography = Vp) and mitral valve closure (Vmin) according to the biplane area-length method. RESULTS: The mean age, gestational age, weight and body surface area were similar in pre-eclampsia and controls. The ventricular septal and posterior wall thickness were greater in pre-eclampsia (P < 0.001). There were no significant differences in LA diameter, Vmax, Vmin, Vp, LA-passive emptying volume, LA-passive emptying fraction, LA-active emptying volume, LA-active emptying fraction, conduit volume, LA-total emptying volume and LA-total emptying fraction between the groups. CONCLUSION: Left atrial mechanical function didn't change in pre-eclampsia. We conclude that short-lasting pressure overload is not capable of inducing changes in LA function.

Adult↗
PubMed2002

Effect of haemodialysis on left atrial mechanical function in patients with chronic renal failure.

OBJECTIVE: The aim of this study was to investigate the potential effects of haemodialysis on left atrial (LA) mechanical functions in patients with chronic renal failure. METHODS: Thirty-two patients with chronic renal failure (mean age 42.8 +/- 19.6 years) were included in this study. LA volumes were determined echocardiographically at the time of mitral valve opening (maximal,Vmax), at the onset of atrial systole (p wave at the electrocardiography = Vp) and at the mitral valve closure (minimal, Vmin) according to the biplane area-length method in apical 4-chamber and 2-chamber view. All volumes were corrected to the body surface area, and the following left atrial emptying functions were calculated. LA passive emptying volume = Vmax - Vp, LA passive emptying fraction = LA passive emptying volume/Vmax. Conduit volume = LV stroke volume-(Vmax - Vmin), LA active emptying volume = Vp Vmin. LA active emptying fraction = LA active emptying volume/Vp, LA total emptying volume = (Vmax - Vmin), LA total emptying fraction = LA total emptying volume/Vmax. RESULTS: Mean fluid removal was 1,875 +/- 812 milliliter. There was no difference between in the LA passive emptying volume before and after dialysis (10.83 +/- 7.44 vs. 11.47 +/- 7.73 cm3/m2, p > 0.05). Conduit volume (from 15.30 +/- 10.68 to 10.31 +/- 6.83 cm3/m2, p < 0.05), LA active emptying volume (from 12.61 +/- 6.39 to 9.25 +/- 4.40 cm3/m2, p < 0.005), LA total emptying volume (from 23.44 +/- 8.52 to 20.72 +/- 8.58 cm3/m2, p < 0.05), LA maximal volume (from 39.44 +/- 14.07 to 28.89 +/- 11.80 cm3/m2, p < 0.001), LA minimal volume (from 15.99 +/- 9.70 to 8.17 +/- 4.52 cm3/m2, p < 0.001), and the volume at the onset of atrial systole (from 28.61 +/- 10.36 to 17.42 +/- 7.20 cm3/m2, p < 0.001) decreased significantly after the haemodialysis session, whereas LA passive emptying fraction (from 0.27 +/- 0.14 to 0.38 +/- 0.14%, p < 0.001), LA active emptying fraction (from 0.46 +/- 0.18 to 0.53 +/- 0.17%, p < 0.05), LA total emptying fraction (from 0.61 +/- 0.14 to 0.72 +/- 0.09%, p < 0.001) increased significantly after haemodialysis. CONCLUSION: The results of this study suggest that left atrial mechanical functions improve after haemodialysis in patients with chronic renal failure.

Adult↗
PubMed1997

Left atrial appendage function during DDD and VVI pacing.

OBJECTIVE: To examine, using transoesophageal echocardiography, the possible disturbances of left atrial appendage function during VVI and DDD pacing in patients with a normal atrium paced with a dual chamber system. DESIGN: Randomised controlled trial. SETTING: Tertiary care centre. PATIENTS: 22 patients (mean age 68 (SD 6) years) who had been paced with dual chamber pacemakers for at least six months. Exclusion criteria were valvar disease, cardiomyopathy, hypertension, and diabetes mellitus. INTERVENTIONS: All patients underwent a transoesophageal echocardiographic evaluation of left atrial appendage function under DDD and VVI modes in random order. Measurements were made after at least two months' pacing in each mode. MAIN OUTCOME MEASURES: Echocardiographic indices of left atrial appendage flow under both pacing modes. RESULTS: All 22 patients had higher emptying and filling flow velocities under DDD than under VVI mode. The filling and emptying flow velocity integrals were also significantly higher under DDD mode (P < 0.001, P = 0.019). CONCLUSIONS: Left atrial appendage function, as reflected in indices of emptying and filling assessed by transoesophageal echocardiography, is significantly different with DDD than with VVI pacing. This may explain the higher incidence of thromboembolic episodes in patients paced under VVI mode.

Aged↗
PubMed2000

Transesophageal echocardiography assessment of left atrial appendage function in untreated systemic hypertensive patients in sinus rhythm.

To assess left atrial appendage (LAA) function in hypertensive patients without treatment, transesophageal echocardiography (TEE) was performed in 46 hypertensive patients in sinus rhythm, aged 40 to 55 years, and in 16 control subjects (group I) without cardiovascular disease, aged 41 to 54 years. The hypertensive patients were divided into 2 groups according to left ventricular (LV) systolic function: group II, the group with normal LV systolic function (ejection fraction 0.63 +/- 0.08), and group III, the group with LV systolic dysfunction (ejection fraction 0.39 +/- 0.05). The LAA late emptying velocities (EVs) were significantly reduced in the hypertensive subgroups compared with the control group (P <.001), but no significant difference in the LAAEV was found between groups II and III. The LAAEV in the hypertensive patients had a significant negative correlation with diastolic blood pressure, systolic blood pressure, and left atrial (LA) diameter. The maximal LAA areas were significantly larger in the hypertensive subgroups than in the control group (P <.05). No significant difference in LAA maximal area existed between groups II and III. The maximal LAA area in the hypertensive patients had a significant positive correlation with diastolic blood pressure, systolic blood pressure, and LA diameter, but a significant negative correlation with LV ejection fraction. With TEE, LA spontaneous echocardiographic contrast (SEC) was present in 6 (43%) of 14 patients in group III (P <.01) and in 7 (22%) of 32 patients in group II (P <.05). No significant difference in the occurrence of LASEC was found between groups II and III. Left atrial appendage thrombi by TEE were observed in 4 (29%) of 14 patients in group III (P <.05) and in 4 (13%) of 32 patients in group II (P = not significant). No significant difference in the occurrence of LAA thrombus existed between groups II and III. In conclusion, in patients with untreated hypertension, marked elevation of afterload imposed on the left atrium may involve both the left atrium and the LAA, resulting in impairment of LAA function. This condition may worsen with subsequent occurrence of SEC and later, thrombus formation. Therefore assessment of LAA function may be important even in the hypertensive patient in sinus rhythm.

Adult↗
PubMed1993

Left atrial appendage smoke-like echo in dilated cardiomyopathy: its clinical significance and relation to left atrial appendage function.

To elucidate the clinical significance and pathogenesis of left atrial appendage smoke-like echo in dilated cardiomyopathy (DCM), clinical history and transesophageal echocardiographic assessment of left atrial appendage (LAA) anatomy and function were studied in 18 DCM patients with smoke-like echo (SE), 34 patients with DCM but no smoke-like echo and in 14 age-matched normal subjects. Patients with SE had a larger left atrial appendage area, a lower peak LAA systolic flow velocity (PLAAV), a greater incidence of atrial fibrillation, with both left atrial appendage thrombi and a history of arterial embolic episodes, than did patients without SE. Patients in sinus rhythm with SE had a minimal LAA area (5.0 +/- 3.0 cm2) larger than that in the no SE group (3.0 +/- 1.6 cm2) (p < 0.05), and LAA ejection fraction (18 +/- 10%) and PLAAV (24 +/- 9 cm/sec) less than that in the no SE group (40 +/- 11% and 39 +/- 16 cm/sec, respectively) (P < 0.05). Patients with atrial fibrillation (AF) and SE had PLAAV (15 +/- 6 cm/sec) less than that in AF patients without SE (30 +/- 12 cm/sec) (p < 0.05). It is concluded that smoke-like echo in LAA is an indicator of DCM patients with an increased thromboembolic risk usually associated with dilated and poorly contractile LAA.

Adult↗
PubMed2002

Left atrial appendage function in patients with mitral stenosis in sinus rhythm.

AIMS: Left atrial appendage thrombi are believed to be the source of embolism in patients with rheumatic mitral stenosis in atrial fibrillation. There are a few studies which search the effects of left atrial appendage dysfunction in patients with mitral stenosis in sinus rhythm. METHODS AND RESULTS: Left atrial appendage function and flow patterns in 41 patients with rheumatic mitral stenosis in sinus rhythm and 11 healthy subjects were studied by transoesophageal echocardiography. Left atrial appendage flow profiles were recorded within the proximal third of the appendage. The left atrial appendage ejection fraction was expressed as (maximal area of appendage minimal area of appendage)/maximal area of appendage. In addition, two-dimensional imaging was used to determine the presence of spontaneous echocardiographic contrast and thrombus formation. Patients with mitral stenosis in sinus rhythm had significantly decreased left atrial appendage emptying and filling velocities compared to controls (0.40+/-0.15m/s vs 0.82+/-0.19 m/s and 0.42+/-0.21 m/s vs 0.68+/-0.28, respectively, P<0.001 and P<0.05). Compared with the control subjects, patients with mitral stenosis had significantly greater maximal area of the appendage and had reduced left atrial appendage ejection fraction (5.3+/-2.2 cm(2) vs 2.4+/-0.5 cm(2) and 50+/-16% vs 70+/-7%, respectively, P<0.001 and P<0.05). Of the patients with mitral stenosis in sinus rhythm, seven patients had spontaneous echocardiographic contrast and one of these had left atrial appendage thrombus. Compared with patients without spontaneous echocardiographic contrast, patients with spontaneous echocardiographic contrast had decreased left atrial appendage ejection fraction (33+/-21% vs 54+/-13%,P <0.01). One of the patients with mitral stenosis had central retinal artery occlusion, but thrombus was not observed in left atrial appendage. CONCLUSION: The study found that left atrial appendage dysfunction may occur in patients with mitral stenosis in sinus rhythm.

Adult↗
PubMed1999

Left atrial systolic time interval in hyperthyroidism.

The author noninvasively examined effects of thyroid hormone on left atrial function by using the left atrial systolic time intervals (LASTI) with its parameters as left atrial ejection time (LAET), left atrial preejection period (LAPEP), and LAET/LAPEP, as measured by pulsed Doppler echocardiography. The hyperthyroid (HTH) and normal control (NC) groups consisted of 21 and 25 subjects, respectively. He also considered serum triiodothyronine (T3) concentrations, age, heart rate, systolic blood pressure, left ventricular preload, afterload, contractility, diastolic function, P wave duration, PR interval, and left ventricular preejection period (LVPEP) as factors that might influence LASTI. LAET, LAET/LAPEP, and LVPEP in the HTH group were significantly shorter than in the NC group. LAET showed no significance with serum T3 concentration, but did with LVPEP in partial correlation analysis. These results demonstrated that a short LAET in the hyperthyroid state is controlled by a rapid rise in the left ventricular pressure.

Adult↗