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Decreased left atrial appendage function is an important predictor of elevated left ventricular filling pressure in
1Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Insights
Left atrial appendage function, measured by blood flow velocities and ejection fraction, can predict elevated left ventricular filling pressure in heart failure patients. This non-invasive echocardiography method aids in assessing heart failure severity.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure
Background:
- Elevated left ventricular filling pressure is a key indicator of heart failure severity.
- Assessing this pressure non-invasively is crucial for patient management.
Purpose of the Study:
- To determine if left atrial appendage (LA) function can predict elevated left ventricular filling pressure in chronic congestive heart failure patients.
- To evaluate the utility of LA appendage blood flow velocities and ejection fraction for this prediction.
Main Methods:
- Transesophageal echocardiography was used to measure LA appendage active emptying and filling velocities and ejection fraction in 25 heart failure patients.
- Left ventricular end-diastolic pressure was measured via cardiac catheterization within 24 hours.
Main Results:
- LA appendage emptying velocity, filling velocity, and ejection fraction showed significant negative correlations with left ventricular end-diastolic pressure.
- An active emptying velocity <30 cm/s accurately predicted elevated left ventricular end-diastolic pressure (>25 mm Hg) with high sensitivity and specificity.
Conclusions:
- LA appendage blood flow velocities and contractile function, assessed by transesophageal echocardiography, are valuable predictors of elevated left ventricular filling pressure.
- These echocardiographic parameters offer a non-invasive method for assessing filling pressures in heart failure.
Objective:
The aim of this study was to investigate whether left atrial (LA) appendage function, as indicated by LA appendage blood flow velocities and its ejection fraction, could identify elevated left ventricular filling pressure in patients with chronic congestive heart failure.
Methods:
Using transesophageal echocardiography, adequate pulsed Doppler LA appendage active emptying and filling velocities could be recorded in 25 consecutive patients (16 men and 9 women, aged 57+/-10 years) with chronic congestive heart failure (symptom duration > or =1 year). LA appendage ejection fraction calculated as (LA appendage maximal area)-(LA appendage minimal area)/(LA appendage maximal area) x 100 was also determined in these patients. Left ventricular end-diastolic pressure was recorded during cardiac catheterization performed within 24 h of echocardiographic study.
Results:
Left ventricular end-diastolic pressure was 2 to 47 mm Hg. There were close negative correlations of LA appendage emptying velocity (r=-0.508; P<0.01), filling velocity (r=-0.429; P<0.05) and LA appendage ejection fraction (r=-0.523; P<0.005) with left ventricular end-diastolic pressure. LA appendage active emptying velocity <30 cm/s predicted left ventricular end-diastolic pressure >25 mm Hg with a sensitivity of 72.7%, a specificity of 92.9% and a positive and negative predictive value of 88.9 and 81.3%.
Conclusions:
The findings suggest that measurement of LA appendage blood flow velocities and contractile function by transesophageal echocardiography can be used to predict elevated left ventricular filling pressure in patients with congestive heart failure.