title: Speckle-Tracking Strain Imaging Identifies Alterations in Left Atrial Mechanics With General Anesthesia and Positive-Pressure Ventilation.
abstract: OBJECTIVE
  The primary aim of this study was to use speckle-tracking strain imaging to evaluate the effect of general anesthesia (GA) and positive-pressure ventilation (PPV) on left atrial (LA) mechanics. The authors hypothesized that GA and PPV would be associated with a decrease in LA strain. The secondary aims were to investigate the effects of GA and PPV on traditional Doppler-derived measures of LA function and Doppler echocardiographic grade of diastolic function.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Adult patients undergoing cardiac surgery.
  
  
  METHODS
  Transthoracic echocardiography was performed at baseline and under GA with PPV.
  
  
  RESULTS
  Changes in LA function associated with GA and PPV were assessed using LA speckle-tracking strain imaging. A reduction was observed in LA peak longitudinal strain (24% v 18%, p<0.001) and preatrial contraction strain (13% v 8%, p<0.001). No difference was seen in LA contraction strain or atrial ejection fraction. Indexed LA volume and Doppler diastolic indices also were reduced significantly, and 39% of patients had a change in measured diastolic grade under GA with PPV.
  
  
  CONCLUSIONS
  Speckle-tracking strain imaging of the left atrium demonstrated that GA and PPV had a significant impact on LA mechanics by decreasing strain measures of LA preload, with a lesser effect on LA contractility.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Howard-Quijano
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
authors.forename: John
authors.initials: J
authors.lastname: Anderson-Dam
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Melissa
authors.initials: M
authors.lastname: McCabe
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hall
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Einat
authors.initials: E
authors.lastname: Mazor
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA. Electronic address: amahajan@mednet.ucla.edu.
authors.forename: Aman
authors.initials: A
authors.lastname: Mahajan
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects*; D016279:Atrial Function, Left / Q000502:physiology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D011446:Prospective Studies
keywords: cardiac surgery; left atrial mechanics; speckle tracking; strain; transthoracic echocardiography