title: Role of the left atrial function on the pseudonormalization of the transmitral flow velocity pattern evaluated by two-dimensional tissue tracking technique.
abstract: BACKGROUND
  Mechanisms of the pseudonormalization (PN) of the transmitral flow (TMF) velocity pattern have been mainly attributed to left ventricular diastolic function.
  
  
  OBJECTIVE
  To assess the influence of left atrial (LA) function on the PN with two-dimensional tissue tracking technique.
  
  
  METHODS
  The subjects consisted of 21 healthy volunteers and 70 patients with various cardiac diseases. Images of one cardiac cycle in the apical four-chamber view were stored by the HIVISION 900 (Hitachi Medico, Chiba, Japan). The LA volume (LAV) loop was created using two-dimensional tissue tracking technique and LAV index (LAVI) at a given cardiac phase was calculated. A preload of 90mmHg was applied using a customized lower body positive pressure (LBPP) system. Patients were divided into the PN group (n=18) with their early diastolic TMF velocity (E) increased and late diastolic TMF velocity (A) decreased, and the non-(N)-PN group (n=52) with both E and A wave velocities increased by LBPP.
  
  
  RESULTS
  (1) During LBPP, the LAVImax in both the groups increased significantly. (2) In the N-PN group, the LAVIpass (p<0.001), LAVIact (p<0.01), and LAVItotal (p<0.0001) increased significantly. The dV/dts (p<0.0001) and dV/dtE (p<0.0001) increased significantly with an increase in the dV/dtA. On the other hand, there was no change in those parameters except LAVIpass (p<0.05) and dV/dtE (p<0.05) significantly increased in the PN group. (3) As a result, the LAVImin was significantly greater in the PN group than in the N-PN group (p<0.0001) during LBPP. The ratio of E velocity to early diastolic mitral annular velocity (E/E') during LBPP was significantly greater in the PN group than in the N-PN group (p<0.0001).
  
  
  CONCLUSIONS
  The lack of an increase in active LA emptying volume in response to an increase of preload leads to elevated LA pressure and the pseudonormalization of the TMF velocity pattern in patients with various cardiac diseases.
authors.affiliation: The Division of Cardiology, Fujita Health University Second Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya 454-8503, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Mukaide
authors.forename: Tomotsugu
authors.initials: T
authors.lastname: Tabata
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kinoshita
authors.forename: Hiroatsu
authors.initials: H
authors.lastname: Yokoi
authors.forename: Wakaya
authors.initials: W
authors.lastname: Fujiwara
authors.forename: Osamu
authors.initials: O
authors.lastname: Inami
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Sugishita
authors.forename: Gen
authors.initials: G
authors.lastname: Ukai
authors.forename: Masataka
authors.initials: M
authors.lastname: Yoshinaga
authors.forename: Tomohito
authors.initials: T
authors.lastname: Kamada
authors.forename: Masanori
authors.initials: M
authors.lastname: Nomura
authors.forename: Hideo
authors.initials: H
authors.lastname: Izawa
mesh_terms: D000328:Adult; D000368:Aged; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006331:Heart Diseases / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016277:Ventricular Function, Left / Q000502:physiology*