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Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review.

Liza Thomas1, Thomas H Marwick2, Bogdan A Popescu3

  • 1University of Sydney, Sydney, NSW, Australia; Department of Cardiology Westmead Hospital; South West Clinical School, University of New South Wales, Sydney, NSW, Australia.

Journal of the American College of Cardiology
|April 20, 2019
PubMed
Summary
This summary is machine-generated.

Left atrial function is crucial for diagnosing diastolic dysfunction and heart failure. New metrics offer better insights than volume alone, aiding early detection and treatment monitoring.

Keywords:
2-dimensional echocardiography3-dimensional echocardiographyheart failure with preserved ejection fractionleft atrial fibrosisleft atriumleft ventricular diastolic functionphasic functionspeckle-tracking echocardiographyvolumes

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Area of Science:

  • Cardiology
  • Echocardiography
  • Heart Failure Research

Background:

  • Left atrial (LA) function is increasingly recognized as vital for assessing left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction (HFpEF).
  • Current echocardiographic methods for LVDD diagnosis, while simplified, have limitations, leaving LVDD presence and severity undetermined in many patients.
  • Maximum LA volume (LAV) is a surrogate for LVDD chronicity but insensitive to early stages, as LA remodeling takes time.

Purpose of the Study:

  • To critically review existing evidence on the utility of LA metrics in evaluating LVDD.
  • To assess the role of LA function in diagnosing and grading HFpEF.
  • To explore the potential of LA functional changes in monitoring treatment efficacy for LVDD and HFpEF.

Main Methods:

  • Review of current literature and echocardiographic guidelines on LVDD and HFpEF assessment.
  • Analysis of the limitations of standard echocardiographic parameters (transmitral flow, tissue velocity, LAV, estimated pulmonary artery systolic pressure).
  • Evaluation of the emerging role of LA functional parameters beyond volumetric assessment.

Main Results:

  • LA functional changes are detectable early in LVDD due to the LA's role in modulating LV filling.
  • LA function provides additive value in diagnosing LVDD and grading its severity.
  • LA metrics may be essential for monitoring therapeutic responses in LVDD and HFpEF.

Conclusions:

  • Standard echocardiographic assessments for LVDD and HFpEF have significant limitations.
  • LA function offers a more sensitive biomarker for early LVDD detection and severity grading than LAV alone.
  • Comprehensive assessment of LA function is crucial for accurate diagnosis and management of LVDD and HFpEF.