Left Atrial Contractility in Ischemic Heart Disease Patients with Left Ventricular Systolic Dysfunction

Left atrial (LA) active emptying plays an important role in left ventricular (LV) filling. It not only depends on LA preload but also on LA contractility. Our aim was to assess LA wall contraction velocity (LAWV) and its relation to each of LA active stroke volume index (LAASVI) and LA active emptying fraction (LAAEF) as markers of LA active emptying in patients with ischemic heart disease (IHD) and impaired LV systolic function.

We studied 50 consecutive patients with stable IHD and LV ejection fraction <45% and 50 healthy controls. Standard echocardiography assessed: Biplane LV volumes and ejection fraction, trans-mitral Doppler E and A wave velocities and E/A ratio, indexed biplane LA volumes pre- and post-atrial contraction, LAASVI and LAAEF. LAWV was measured by tissue Doppler imaging.

Trans-mitral Doppler A velocity was lower in the study group 60.64 ± 20.6 vs 72.46 ± 17.13 cm/s (P = 0.002). Accordingly, E/A ratio was higher in the study group 1.32 ± 0.78 vs 0.92 ± 0.3 (P < 0.0001). Indexed biplane LAV-pre atrial contraction was larger in the study group 23.61 ± 3.8 vs 17.16 ± 3.57mL/m² (P < 0.0001). Indexed biplane LAV-post atrial contraction was larger in the study group 16.22 ± 4.14 vs 13.19 ± 3.56mL/m² (P=0.0002). Accordingly, biplane LAASVI was higher in the study 53 group 7.9 ± 1.26 vs 3.96 ± 0.63 mL/m² (P < 0.0001). LAAEF was larger in the study group 32.37 ± 8.89 vs 24.31 ± 7.12% (P < 0.0001). LAWV was lower in the study group 6.78 ± 0.51 vs 10.58 ± 0.67 cm/sec (P < 0.0001).

In patients with IHD and impaired LV systolic function, LA wall contractility is reduced. However, LAASVI and LAAEF are enhanced.