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Published on: December 22, 2023
Left atrial vortex flow and its relationship with left atrial functions in patients with congenital heart disease
Keita Ito1, Hideharu Oka2, Yuki Shibagaki1
1Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan.
Insights
The absence of left atrial vortex flow (LAVF) in congenital heart disease (CHD) patients may indicate early left atrial dysfunction. Four-dimensional flow MRI revealed LAVF is often lost in postoperative CHD patients, correlating with reduced left atrial function.
Area of Science:
- Cardiovascular Imaging
- Cardiac Physiology
- Congenital Heart Disease Research
Background:
- Four-dimensional flow MRI visualizes blood flow, aiding in understanding left atrial vortex flow (LAVF).
- Absence of LAVF is linked to thrombus formation and arrhythmias.
- The clinical significance of LAVF in congenital heart disease (CHD) patients is not well-established.
Purpose of the Study:
- To investigate the relationship between LAVF and left atrial function in patients with CHD.
- To determine if LAVF is altered in postoperative CHD patients.
Main Methods:
- Utilized four-dimensional flow MRI (velocity encoding 100 cm/s) to assess LAVF presence.
- Evaluated left atrial function using transthoracic echocardiography.
- Included 8 postoperative CHD patients and 17 healthy volunteers, all in sinus rhythm.
Main Results:
- LAVF was detected in 16 participants.
- Postoperative CHD patients were more likely to lack LAVF (78%) compared to volunteers (6%).
- Participants without LAVF exhibited significantly lower left atrial ejection fraction, reservoir, and conduit function.
Conclusions:
- Left atrial vortex flow (LAVF) occurs late in ventricular systole, potentially influenced by reservoir function.
- Many postoperative CHD patients demonstrated a loss of LAVF.
- Absence of LAVF may signify early left atrial dysfunction due to remodeling in CHD.
Background:
Four-dimensional flow magnetic resonance imaging (MRI) enables blood flow visualization. The absence of left atrial vortex flow (LAVF) has been implicated in the development of thrombus formation and arrhythmias. However, the clinical relevance of this phenomenon in patients with congenital heart disease (CHD) remains unclear. This study aimed to unravel the relationship of LAVF with left atrial functions in patients with CHD.
Results:
Twenty-five participants who underwent cardiac MRI examinations were included (8 postoperative patients with CHD aged 17-41 years and 17 volunteers aged 21-31 years). All participants were in sinus rhythm. Four-dimensional flow MRI (velocity encoding 100 cm/s) assessed the presence of LAVF, and its relationship with left atrial function determined by transthoracic echocardiography was explored. LAVF was detected in 16 patients. Upon classification of the participants based on the presence or absence of LAVF, 94% of participants in the LAVF group were volunteers, while 78% of those in the without LAVF group were postoperative patients. Participants without LAVF had a significantly lower left atrial ejection fraction (61% vs. 70%, p = 0.019), reservoir (32% vs. 47%, p = 0.006), and conduit (22% vs. 36%, p = 0.002) function than those with LAVF.
Conclusions:
LAVF occurred during the late phase of ventricular systole, and left atrial reservoir function may have contributed to its occurrence. Many postoperative patients with CHD experienced a loss of LAVF. LAVF may indicate early left atrial dysfunction resulting from left atrial remodeling.
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