Left Atrial Function Analysis in Patients in Sinus Rhythm, Normal Left
Ventricular Function and Indeterminate Diastolic Function
Abstract
Background In ~25% of echo studies discrepant diastolic
measurements make the assessment of diastolic function indeterminate. We
aimed to assess whether left atrial function may contribute to LV
filling evaluation in patients with indeterminate diastolic function
(IndtDFx). Methods In our retrospective echocardiography database we
found 1674 consecutive patients in sinus rhythm, and EF≥45%. Patients
were divided according to the parameters mitral E’, mitral E/E’ ratio ,
left atrial maximal volume index , and pulmonary pressure. Normal
diastolic function (NDFx) was defined as less than 2 abnormal
parameters, definite diastolic dysfunction (DDFx) as more than 2
abnormal parameters, and IndtDFx as 2 abnormal parameters. We
retrospectively and randomly selected 30 patients from each group for
left atrial assessment by speckle tracking echocardiography for off line
strain and volumes analysis. Results: sixty seven patients were included
in strain analysis. The DDFx group (n=21) and IndtDFx (n=19) were
significantly different form NDFx (27) in demographics, cardiovascular
risk factors., presentation and echocardiographic parameters. Phasic LA
maximal and minimal volume indexes were larger in DDFx and indtDFx
groups, and overall and passive LA strains were decreased in DDFx and
indtDFx groups compared with NDFx group, while active strain remained in
the normal range. Phasic LA minimal volume index was found to be
associated with HF symptoms. Conclusion LA phasic function suggests that
IndtDFx is similar to DDFx , helping in re- classification of patients
with IndtDFx as DDFx. LA minimal volume index correlated with symptoms.