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Relationship of phasic left atrial volume and emptying function to left ventricular filling pressure: a
Kanna Posina, Jeannette McLaughlin, Peter Rhee
1St, Francis Hospital, Roslyn, NY, USA. Jane.Cao@chsli.org.
Insights
Increased left atrial volume at minimum (LAV(min)) and decreased global left atrial emptying fraction (LAEF(Total)) best identify elevated left ventricular end diastolic pressure (LVEDP). These cardiac magnetic resonance (CMR) findings aid in assessing diastolic dysfunction.
Area of Science:
- Cardiology
- Cardiac Imaging
- Diagnostic Biomarkers
Background:
- Left atrial volume (LAV) and emptying fraction (LAEF) are dynamic cardiac parameters.
- Their precise relationship with left ventricular end diastolic pressure (LVEDP) requires further elucidation.
Purpose of the Study:
- To investigate the association between phasic LAV and LAEF with elevated LVEDP.
- To determine which phasic LAV and LAEF indices are most effective in identifying increased LVEDP.
Main Methods:
- Cardiovascular magnetic resonance (CMR) was used to assess LAV and LAEF in 41 patients.
- Phasic LAV (LAV(max), LAV(min), LAV(ac)) and LAEF (LAEF(Total), LAEF(Passive), LAEF(Contractile)) were quantified.
- Receiver operating characteristic (ROC) analysis was employed to compare the diagnostic performance of these indices for elevated LVEDP.
Main Results:
- Left atrial volume at minimum (LAV(min)) showed a significant association with elevated LVEDP (AUC 0.765, p=0.002).
- Global left atrial emptying fraction (LAEF(Total)) demonstrated the strongest association with elevated LVEDP (AUC 0.780, p=0.001).
- LAEF(Contractile) also showed a significant association (AUC 0.698, p=0.022).
Conclusions:
- Increased LAV(min) and decreased LAEF(Total) are the most effective phasic indices for identifying elevated LVEDP.
- These findings highlight the utility of specific phasic left atrial parameters in assessing diastolic pressure.
- Further research is warranted to explore the clinical implications of these phasic LA indices.
Background:
Left atrial volume (LAV) and emptying fraction (LAEF) are phasic during cardiac cycle. Their relationships to left ventricular end diastolic pressure (LVEDP) have not been fully defined.
Methods:
Forty one patients undergoing clinically indicated left heart catheterization were recruited for same day cardiovascular magnetic resonance (CMR). LAV and LAEF were assessed in cine images using biplane area and length method. Three phasic LAV was assessed at LV end systole (LAV(max)), LV end diastole (LAV(min)) and late LV diastole prior to LA contraction (LAV(ac)). LAEF was assessed as global LAEF (LAEF(Total)), passive (LAEF(Passive)) and active LAEF (LAEF(Contractile)). The relationships of phasic LAV and LAEF to LVEDP were assessed using Receiver operating characteristic comparing areas under the curves (AUC).
Results:
The mean age of the patients was 59 years. A history of heart failure was present in 16 (39%) with NYHA functional class III or IV in 8 (20%) patients. Average LV ejection fraction was 49 ± 16% ranging from 10% to 74% and LVEDP by catheterization 14 ± 8 mmHg ranging from 4 mmHg to 32 mmHg. LAV(min) had the strongest association with LVEDP elevation (>12 mmHg) (AUC 0.765, p = 0.002), as compared to LAV(max) (AUC 0.677, p = 0.074) and LAV(ac) (AUC 0.735, p = 0.008). Among three phasic LAEF assessed, LAEF(Total) had the closest association with LVEDP elevation (AUC 0.780, p = 0.001), followed by LAEF(Contractile) (AUC 0.698, p = 0.022) and LAEF(Passive) (AUC 0.656, p = 0.077).
Conclusions:
Increased LAV(min) and decreased LAEF(Total) have the best performance in identifying elevated LVEDP among three phasic LAV and LAEF analyzed. Future studies should further characterize LA phasic indices in clinical outcomes.
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