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Associations of left atrial volumes and Doppler filling indices with left atrial function in acute myocardial infarction
Vastmanland Cty Hosp, Dept Clin Physiol, SE-72189 Vasteras, Sweden.
Vastmanland Cty Hosp, Dept Clin Physiol, SE-72189 Vasteras, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanland Cty Hosp, Dept Clin Physiol, SE-72189 Vasteras, Sweden.ORCID iD: 0000-0001-5731-966x
2019 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 39, no 1, p. 85-92Article in journal (Refereed) Published
Abstract [en]

Recent findings suggest that left atrial (LA) function is more strongly related to adverse prognosis than LA volumes. We aimed to evaluate the associations between LA volumes and Doppler filling indices with LA function. Echocardiographic LA volumes (LAVs), mitral valve early (MV-E) and late (MV-A) peak flow velocities, and mitral atrioventricular plane tissue-Doppler early (TD-e ') and late (TD-a ') peak velocities were obtained in 320 patients with acute myocardial infarction (AMI) free from atrial fibrillation and more than moderate valvular disease. LA function was estimated as the LA emptying fraction (LAEF), that is 100x (LAVmax-LAVmin)/LAVmax. LA reservoir volume was calculated as LAVmax-LAVmin and LA transit volume as LV stroke volume-reservoir volume. In restricted cubic spline regression analyses with multivariable adjustment, a reduced LAEF was strongly associated with smaller reservoir volume, larger transit volume, LAVmax, LAVpreA and especially LAVmin. MV-E linearly increased with a lower LAEF, whereas MV-A decreased but only below LAEF levels of approximately 45%. The resulting E/A ratio showed a sudden increase in LAEF levels below similar to 45%. Lower TD-a ' was linearly associated with a lower LAEF. In conclusion, a reduced atrial function was associated with smaller LA reservoir volume, larger LA transit volume, lower TD-a ', a non-linear decrease in MV-A and a non-linear increase in E/A. Our findings are likely a reflection of the adaptation to sustain LV filling volume and counteracting a rise in pulmonary venous pressure in face of an enhanced LV end-diastolic pressure.

Place, publisher, year, edition, pages
WILEY , 2019. Vol. 39, no 1, p. 85-92
Keywords [en]
diastolic function, Doppler indices, echocardiography, left atrium, myocardial infarction
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-372367DOI: 10.1111/cpf.12533ISI: 000451710300012PubMedID: 29961999OAI: oai:DiVA.org:uu-372367DiVA, id: diva2:1276700
Funder
Erik, Karin och Gösta Selanders FoundationThe Swedish Medical AssociationAvailable from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-01-08Bibliographically approved

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