Analysis of left atrial volume change rate for evaluation of left ventricular diastolic function.
An excellent correlation exists between the change in the left atrial (LA) angiographic area and posterior aortic wall motion. The aim of the study was to define the role of posterior aortic wall motion, indicating LA volume change, during the left ventricular (LV) phase for the assessment of LV diastolic function. A total of 155 patients underwent echocardiography after cardiac catheterization. Study patients were classified into four groups according to the ratio of early-to-late transmitral flow velocity (E/A ratio) and/or LV end-diastolic pressure (EDP): 42 patients with LVEDP < 15 mmHg and E/A ratio > 1 (normal filling); 46 patients with E/A < 1 (impaired relaxation); 46 patients with LVEDP > or = 15 mmHg and E/A > 1 and < 2 (pseudonormal filling); 21 patients with E/A > 2, E > or = 70 cm/s, and E-wave deceleration time < or = 160 ms (restrictive filling). The slopes of early and late (slopes E and A) diastolic motion of LA wall were derived from M-mode analysis, together with the LV isovolumic time constant Tau from cardiac catheterization. Values of slope E/A decreased in restrictive filling, pseudonormal filling, and impaired relaxation as compared with normal filling (0.41 +/- 0.14, 0.69 +/- 0.15, and 0.56 +/- 0.23 vs 1.25 +/- 0.26, P < 0.001, respectively) and correlated inversely with the isovolumic time constant Tau (r = 0.79, P < 0.001). In cases for which a value of slope E/A < 1 was obtained, indicating a relaxation abnormality, the M-mode derived pattern of LA wall motion identified the underlying abnormal LV diastolic function with a sensitivity of 98.3%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 95.2%. Analysis of the slope of LA wall motion, indicating LA volume change rate, during LV diastolic phase is useful in evaluating LV diastolic function. It provides a new noninvasive index that correlates well with invasive index of LV relaxation.
Hung
Ming-Jui
MJ
The Cardiology Section, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. Ruby800@cgmh.org.tw
Cherng
Wen-Jin
WJ
D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002306:Cardiac Volume; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000503:physiopathology; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016277:Ventricular Function, Left