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Echocardiographic Evaluation of Left Atrial Mechanics: Function, History, Novel Techniques, Advantages, and Pitfalls.

Leischik R, Littwitz H, Dworrak B, Garg P, Zhu M, Sahn DJ, Horlitz M - Biomed Res Int (2015)

Bottom Line: However, the above-mentioned parameters do not directly quantify LA performance.Deformation studies using strain and strain-rate imaging to assess LA function were validated in previous research, but this technique is not currently used in routine clinical practice.This review discusses the history, importance, and pitfalls of strain technology for the analysis of LA mechanics.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.

ABSTRACT
Left atrial (LA) functional analysis has an established role in assessing left ventricular diastolic function. The current standard echocardiographic parameters used to study left ventricular diastolic function include pulsed-wave Doppler mitral inflow analysis, tissue Doppler imaging measurements, and LA dimension estimation. However, the above-mentioned parameters do not directly quantify LA performance. Deformation studies using strain and strain-rate imaging to assess LA function were validated in previous research, but this technique is not currently used in routine clinical practice. This review discusses the history, importance, and pitfalls of strain technology for the analysis of LA mechanics.

No MeSH data available.


Related in: MedlinePlus

(a) Doppler and hemodynamic flow and pressure curves in patients with a delayed relaxation filling pattern. (b) Patients with restrictive filling patterns, adapted from Thomas et al. [40].
© Copyright Policy - open-access
Related In: Results  -  Collection


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fig1: (a) Doppler and hemodynamic flow and pressure curves in patients with a delayed relaxation filling pattern. (b) Patients with restrictive filling patterns, adapted from Thomas et al. [40].

Mentions: William Harvey discussed the important role of the auricles in 1628: “blood enters the ventricles… by the beat of the auricles” and “… they are filled as reservoirs” [22]. A young American who studied the physiological properties of frog hearts in Leipzig in 1869 described the special “electric” nature of heart muscle [23]. Contrary to our scientific expectation, Howell and Donaldson but not Starling described the influence of fluid volume on ventricular performance for the first time in 1884. Frank [24] laid the foundation for the basic regulation of the Frank-Starling Law in 1895. Henderson, in 1906 [25], and Henderson and Barringer Jr., in 1913 [26], suggested fixed relaxation and diastolic capacity patterns. In 1911, Gesell [27] described the influence of auricular systole and its relationship to left ventricular output, and Patterson and Starling further described the impact of venous inflow for determining cardiac output and the role of the connections between venous inflow and outflow in the early 1900s [28]. Independently of Starling and coworkers, the German physiologist Straub [29] published the role of diastolic filling (venous pooling) on ventricular performance, and Wiggers [30] examined which factors influenced right ventricular function. Wiggers [31], who directly witnessed the interesting era from 1900 to 1950 subsequently described the determinants of cardiac performance in the 1950s. Braunwald and coworkers initiated research on the invasive measurements of atrial pressure combined with left ventricular pressures [32]. The relationship between increased left ventricular end-diastolic pressure (LVEDP) and elevated mean LA pressure in patients with left ventricular disease was described for the first time in 1961 [33]. The conduit function can be measured invasively [34] using volume/pressure curves. The experimental and hemodynamic era of heart examinations laid the groundwork for all future noninvasive investigations. Suga [4] concluded that atrial compliance was an important determinant of heart performance as a whole. The contractile nature of nature atria is not fully consistent with the present assumptions that atrial compliance is linear and constant [4]. The normal filling process of more than half of the ventricle during diastole before atrial contraction must be considered. Atrial contraction and deformation are consecutively affected in pathological situations in which the elastic properties of the myocardium are altered [35], leading to changes in the secretory function of the atria [36]. The hemodynamic role of the atria in regulating sodium and as a secretory organ dominated the literature in the late 1980s [36, 37]. The elastic properties of the myocardium and diastolic function have many determinants, which represent a broad area of research [7]. Ideally, simultaneously conducted chamber pressure, volume, flow, and neurohormonal factor (e.g., adrenalin, cortisol, and atrial natriuretic factor) measurements should be considered to examine the LV and LA elastic properties and systolic functions. In 1986, Ishida et al. [38] documented changes in transmitral flow, especially reduced early diastolic transmitral flow during increased afterload, using an invasive technique. Left ventricular filling dynamics and the influence of ventricular relaxation on LA pressure were examined in dogs and were compared to mitral flow. In 1988, Appleton et al. showed a significant relationship between pulmonary wedge pressures and transmitral Doppler velocities [11]. In 1991 [39] and 1997 [40], Thomas et al. compared LA pressures, left ventricular pressures, and transmitral Doppler flow or pulmonary venous flow (Figure 1). Ommen et al. [41] and the Mayo clinic working group simultaneously documented the clinical utility of Doppler and TDI in a comparative Doppler-catheterization study and demonstrated that the noninvasive assessment of LV filling pressures is an important clinical tool.


Echocardiographic Evaluation of Left Atrial Mechanics: Function, History, Novel Techniques, Advantages, and Pitfalls.

Leischik R, Littwitz H, Dworrak B, Garg P, Zhu M, Sahn DJ, Horlitz M - Biomed Res Int (2015)

(a) Doppler and hemodynamic flow and pressure curves in patients with a delayed relaxation filling pattern. (b) Patients with restrictive filling patterns, adapted from Thomas et al. [40].
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4508385&req=5

fig1: (a) Doppler and hemodynamic flow and pressure curves in patients with a delayed relaxation filling pattern. (b) Patients with restrictive filling patterns, adapted from Thomas et al. [40].
Mentions: William Harvey discussed the important role of the auricles in 1628: “blood enters the ventricles… by the beat of the auricles” and “… they are filled as reservoirs” [22]. A young American who studied the physiological properties of frog hearts in Leipzig in 1869 described the special “electric” nature of heart muscle [23]. Contrary to our scientific expectation, Howell and Donaldson but not Starling described the influence of fluid volume on ventricular performance for the first time in 1884. Frank [24] laid the foundation for the basic regulation of the Frank-Starling Law in 1895. Henderson, in 1906 [25], and Henderson and Barringer Jr., in 1913 [26], suggested fixed relaxation and diastolic capacity patterns. In 1911, Gesell [27] described the influence of auricular systole and its relationship to left ventricular output, and Patterson and Starling further described the impact of venous inflow for determining cardiac output and the role of the connections between venous inflow and outflow in the early 1900s [28]. Independently of Starling and coworkers, the German physiologist Straub [29] published the role of diastolic filling (venous pooling) on ventricular performance, and Wiggers [30] examined which factors influenced right ventricular function. Wiggers [31], who directly witnessed the interesting era from 1900 to 1950 subsequently described the determinants of cardiac performance in the 1950s. Braunwald and coworkers initiated research on the invasive measurements of atrial pressure combined with left ventricular pressures [32]. The relationship between increased left ventricular end-diastolic pressure (LVEDP) and elevated mean LA pressure in patients with left ventricular disease was described for the first time in 1961 [33]. The conduit function can be measured invasively [34] using volume/pressure curves. The experimental and hemodynamic era of heart examinations laid the groundwork for all future noninvasive investigations. Suga [4] concluded that atrial compliance was an important determinant of heart performance as a whole. The contractile nature of nature atria is not fully consistent with the present assumptions that atrial compliance is linear and constant [4]. The normal filling process of more than half of the ventricle during diastole before atrial contraction must be considered. Atrial contraction and deformation are consecutively affected in pathological situations in which the elastic properties of the myocardium are altered [35], leading to changes in the secretory function of the atria [36]. The hemodynamic role of the atria in regulating sodium and as a secretory organ dominated the literature in the late 1980s [36, 37]. The elastic properties of the myocardium and diastolic function have many determinants, which represent a broad area of research [7]. Ideally, simultaneously conducted chamber pressure, volume, flow, and neurohormonal factor (e.g., adrenalin, cortisol, and atrial natriuretic factor) measurements should be considered to examine the LV and LA elastic properties and systolic functions. In 1986, Ishida et al. [38] documented changes in transmitral flow, especially reduced early diastolic transmitral flow during increased afterload, using an invasive technique. Left ventricular filling dynamics and the influence of ventricular relaxation on LA pressure were examined in dogs and were compared to mitral flow. In 1988, Appleton et al. showed a significant relationship between pulmonary wedge pressures and transmitral Doppler velocities [11]. In 1991 [39] and 1997 [40], Thomas et al. compared LA pressures, left ventricular pressures, and transmitral Doppler flow or pulmonary venous flow (Figure 1). Ommen et al. [41] and the Mayo clinic working group simultaneously documented the clinical utility of Doppler and TDI in a comparative Doppler-catheterization study and demonstrated that the noninvasive assessment of LV filling pressures is an important clinical tool.

Bottom Line: However, the above-mentioned parameters do not directly quantify LA performance.Deformation studies using strain and strain-rate imaging to assess LA function were validated in previous research, but this technique is not currently used in routine clinical practice.This review discusses the history, importance, and pitfalls of strain technology for the analysis of LA mechanics.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.

ABSTRACT
Left atrial (LA) functional analysis has an established role in assessing left ventricular diastolic function. The current standard echocardiographic parameters used to study left ventricular diastolic function include pulsed-wave Doppler mitral inflow analysis, tissue Doppler imaging measurements, and LA dimension estimation. However, the above-mentioned parameters do not directly quantify LA performance. Deformation studies using strain and strain-rate imaging to assess LA function were validated in previous research, but this technique is not currently used in routine clinical practice. This review discusses the history, importance, and pitfalls of strain technology for the analysis of LA mechanics.

No MeSH data available.


Related in: MedlinePlus