title: Relationship of phasic left atrial volume and emptying function to left ventricular filling pressure: a cardiovascular magnetic resonance study.
abstract: BACKGROUND
  Left atrial volume (LAV) and emptying fraction (LAEF) are phasic during cardiac cycle. Their relationships to left ventricular end diastolic pressure (LVEDP) have not been fully defined.
  
  
  METHODS
  Forty one patients undergoing clinically indicated left heart catheterization were recruited for same day cardiovascular magnetic resonance (CMR). LAV and LAEF were assessed in cine images using biplane area and length method. Three phasic LAV was assessed at LV end systole (LAV(max)), LV end diastole (LAV(min)) and late LV diastole prior to LA contraction (LAV(ac)). LAEF was assessed as global LAEF (LAEF(Total)), passive (LAEF(Passive)) and active LAEF (LAEF(Contractile)). The relationships of phasic LAV and LAEF to LVEDP were assessed using Receiver operating characteristic comparing areas under the curves (AUC).
  
  
  RESULTS
  The mean age of the patients was 59 years. A history of heart failure was present in 16 (39%) with NYHA functional class III or IV in 8 (20%) patients. Average LV ejection fraction was 49 ± 16% ranging from 10% to 74% and LVEDP by catheterization 14 ± 8 mmHg ranging from 4 mmHg to 32 mmHg. LAV(min) had the strongest association with LVEDP elevation (>12 mmHg) (AUC 0.765, p = 0.002), as compared to LAV(max) (AUC 0.677, p = 0.074) and LAV(ac) (AUC 0.735, p = 0.008). Among three phasic LAEF assessed, LAEF(Total) had the closest association with LVEDP elevation (AUC 0.780, p = 0.001), followed by LAEF(Contractile) (AUC 0.698, p = 0.022) and LAEF(Passive) (AUC 0.656, p = 0.077).
  
  
  CONCLUSIONS
  Increased LAV(min) and decreased LAEF(Total) have the best performance in identifying elevated LVEDP among three phasic LAV and LAEF analyzed. Future studies should further characterize LA phasic indices in clinical outcomes.
authors.forename: Kanna
authors.initials: K
authors.lastname: Posina
authors.forename: Jeannette
authors.initials: J
authors.lastname: McLaughlin
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Laura
authors.initials: L
authors.lastname: Li
authors.forename: Joshua
authors.initials: J
authors.lastname: Cheng
authors.forename: William
authors.initials: W
authors.lastname: Schapiro
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Gulotta
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Berke
authors.forename: George A
authors.initials: GA
authors.lastname: Petrossian
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Reichek
authors.affiliation: St, Francis Hospital, Roslyn, NY, USA. Jane.Cao@chsli.org.
authors.forename: Jie J
authors.initials: JJ
authors.lastname: Cao
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D016279:Atrial Function, Left; D006328:Cardiac Catheterization; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left; D017725:Ventricular Pressure