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Left Atrium
Published in Takahiro Shiota, 3D Echocardiography, 2020
Charles Fauvel, Olivier Raitière, Fabrice Bauer
From a more exploratory approach, volume-derived indexes of LA functional assessment can be calculated by 3D echocardiography (Table 5.2, ). Those indexes have been investigated in various diseases and pathophysiological conditions. For instance, LA kick progressively increases with age to compensate for the decline of LA conduit function, while the reservoir function remains unchanged. In dilated cardiomyopathy, both LA reservoir and conduit function decrease while LA kick function increases at an early stage of the disease. A more comprehensive approach of atrial function is given by the time-varying 3D echocardiography LA volume change (Figure 5.4). In this condition, LA volumes can be corroborated to additional 3D strain investigation.
Ventriculography and aortography
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
The left atrial anatomy is complex, and the chamber borders are poorly defined, making assessment of left atrial function and volume somewhat difficult. However, opacifying the LA can be useful for the anatomic evaluation of an atrial septal defect (ASD) or a patent foramen ovale (PFO). Similarly, it may be important to evaluate the left atrial anatomy before and after radiofrequency ablation procedures. In most instances, the anatomy can be assessed quite well with noninvasive means. In fact, because of the complex and highly variable anatomy of the pulmonary veins, MRI and CT are superior to angiographic projection imaging. However, angiographic guidance is necessary for placing ASD, PFO, or left atrial occluder devices. Left atrial angiography is best performed with the NIH catheter, which is placed in the right upper pulmonary vein. This allows contrast material to “wash” along the interatrial septum. A 45° LAO imaging plane with 45° cranial angulation best outlines the septum to show ASDs and PFOs. Injection parameters for left atrial angiography are similar to those for ventriculography, except that lower maximum pressures may be used in the low-pressure LA.
Management of Atrial Fibrillation in Patients with Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Panagiotis Korantzopoulos, Aris Bechlioulis
Improved risk stratification is needed to identify patients with AF and HF who might benefit the most from catheter ablation. For this purpose, several clinical and imaging risk factors have been proposed (Table 20.3).94 Importantly, ablation procedures in recent clinical trials were performed in high-volume centers, whereas different strategies and modalities were used across the studies. Moreover, the studied populations included relatively young males with moderate LV dysfunction and relatively short duration of AF, while the follow-up period was not long. Catheter ablation appears to be more beneficial in patients with HFrEF earlier in the course of disease (NYHA class II, LVEF >25%), who do not have advanced, irreversible myocardial damage (i.e., extensive fibrosis).82,84 The presence of AF by itself is associated with structural and functional abnormalities of the left atrium, which are not entirely resolved by restoration of sinus rhythm, whereas catheter ablation can cause further injury to the atrium as a result of replacement of the normal myocardium with scar. Catheter ablation may be associated with up to 30–35% replacement of left atrium by fibrotic tissue. These changes may be well tolerated in relatively healthy patients with paroxysmal AF, but, in patients with HF and severe structural atrial changes, ablation-related injury may further impair atrial function with subsequent worsening of HF. Although the fibrotic atrium in HF is an ideal substrate for the development of AF, it may be a suboptimal substrate for catheter ablation, as these patients are unlikely to derive long-term benefits from the procedure.95
Correlation between echocardiographic measurements and right heart hemodynamic parameters in patients undergoing evaluation for pulmonary hypertension
Published in Baylor University Medical Center Proceedings, 2022
Omid Hosseini, Benjamin Daines, Sanjana Rao, Shengping Yang, Victor Test, Pooja Sethi, Sofia Prieto, John Abdelmalek, Mohamed Elmassry, Kenneth Nugent
Roca et al measured right atrial function, including reservoir, conduit, and active contraction, using two-dimensional spectral tracking echocardiography in 65 patients.8 Both the longitudinal strain and the early longitudinal strain rate were reduced in patients with pulmonary hypertension compared to controls. Late active contraction in patients was similar to controls. Decreased right atrial longitudinal strain had a negative correlation with right atrial size and right atrial pressure but not pulmonary artery pressure. It was also associated with increased pro-BNP levels. Consequently, these investigators suggested that right atrial reservoir and passive conduit functions are impaired in patients with pulmonary artery hypertension, but active contraction is increased at least initially. These studies would require more expertise and time for additional echocardiographic analysis.
Left atrial evaluation: why rest on your laurels when you can do it better?
Published in Acta Cardiologica, 2022
Guillaume L’Official, Erwan Donal
The speckle-tracking LA analysis is easy and rapidly doing using a dedicated or no-software package (Figure 1). With a loop focussed on the LA, with a correct frame rate (>50–70 frames/sec), the Region Of Interest (ROI) is contoured, the thickness is automatically adapted to the thin LA wall. As recommended by the Taskforce the reference timing of zero strain in the cardiac cycle is gated by an R–R cycle (as the ventricles). This gives us a curve that correctly represents the 3 phases of the atrial function: the first positive peak as RESERVOIR function when the LA fills and stretches; then the opening of the mitral valve with passive LV filling resulting in a strain decrease up to a plateau period = CONDUCT phase, if the patient is in sinus rhythm we see another peak for the atrial systole = the booster PUMP. By the analysis of the different phases, we had a complete evaluation of the LA deformation and function during a cycle, using the same loop that was used to calculate the volume [6].
Right Ventricular-Pulmonary Arterial Coupling and Outcomes in Heart Failure and Valvular Heart Disease
Published in Structural Heart, 2021
Bahira Shahim, Rebecca T. Hahn
Finally, right heart function may be dependent on right atrial function. Recent studies using CMR show that diastolic suction does not appear to be a component of blood flow into the RV. Rather, a number of unique features of the right ventriculo-atrial anatomy help to drive flow across the tricuspid valve annulus. A rotational or helical flow within the right atrium, in part related to the orientation of the superior and inferior vena caval inflows,17 contribute to flow into the RV and also result in conservation of atrial blood flow kinetic energy.18,19 Disruption of rotational flow patterns have been proposed as an indicator of less efficient energy expenditure.18 This may be relevant in the setting of atrial fibrillation. Mizobuchi et al.20 showed that the loss of coordinated atrial contraction resulted in a greater reduction in RV flow (−34.6%) compared to LV flow (−16.2%, p < 0.01).