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Left atrial size and left ventricular function in coronary artery disease: an echocardiographic-angiographic
Insights
Left atrial enlargement, detected by echocardiography, is a significant indicator of advanced coronary artery disease, correlating with myocardial infarction and reduced ejection fraction.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Assessing the severity of CAD and its impact on cardiac function is crucial for patient management.
- Left atrial size is a potential, yet underutilized, marker for cardiac abnormalities.
Purpose of the Study:
- To investigate the correlation between left atrial size, determined by M-mode echocardiography, and the severity of coronary artery disease.
- To evaluate left atrial enlargement as a predictor of hemodynamic and angiographic abnormalities in CAD patients.
Main Methods:
- M-mode echocardiography was performed on 100 patients with coronary artery disease.
- Patients were categorized based on left atrial diameter (≥40 mm vs. <40 mm).
- Correlations were analyzed with electrocardiographic findings, cardiac pressures, ventricular volumes, and coronary angiography results.
Main Results:
- Patients with enlarged left atria (≥40 mm) showed significantly higher rates of left atrial abnormality, myocardial infarction, and triple vessel disease.
- Enlarged left atria correlated with elevated pulmonary capillary wedge and left ventricular end-diastolic pressures.
- Abnormal ejection fraction (<0.5) was more prevalent in patients with enlarged left atria (80% vs. 25%), with a sensitivity of 71% and specificity of 83% for detecting abnormal ejection fraction.
Conclusions:
- M-mode echocardiographic assessment of left atrial size is a valuable, non-invasive marker for identifying advanced hemodynamic and angiographic abnormalities in patients with coronary artery disease.
- Left atrial enlargement serves as an important indicator of disease severity and impaired cardiac function in this population.
Abstract:
M-mode echocardiography was used to determine left atrial size in 100 patients with coronary artery disease undergoing cardiac catheterization. Patients were divided in two groups on the basis of left atrial diameter (greater than or equal to 40 mm in 40 patients and less than 40 mm in 60). Patients with larger left atria had a higher frequency of electrocardiographic evidence of left atrial abnormality (p less than 0.01) and myocardial infarction (p less than 0.001). Pulmonary capillary wedge and left ventricular end-diastolic pressures were higher (p less than 0.005) in patients with larger left atria. An abnormal end-diastolic volume (greater than 100 ml/M2) was observed in 13 patients with enlarged left atria compared to none with normal left atrial size (p less than 0.001). Triple vessel disease was more frequent (63% vs 32%) and single vessel disease less frequent (10% vs 37%) in patients with larger left atria (p less than 0.005). Abnormal left ventricular contractile patterns were noted in 45% of patients with normal left atrial diameters compared to 80% in those with an enlarged left atrium (p less than 0.001). An abnormally low ejection fraction (less than 0.5) was observed in 25% and 80%, respectively, in patients with normal and enlarged left atria (p less than 0.001). Of 58 patients with normal ejection fractions, only 17% had left atrial diameters greater than or equal to 40 mm compared to 71% of 42 patients with abnormally low ejection fractions (p less than 0.001). Of 18 patients with left atrial diameters greater than 42 mm, only two had normal ejection fractions. The mean ejection fraction for patients with left atrial diameters less than 40 mm was 0.63 +/- 0.13 compared to 0.41 +/- 0.18 for those with diameters greater than or equal to 40 mm (p less than 0.001). The sensitivity, specificity, and predictive value for an enlarged left atrium in identifying an abnormal ejection fraction were, respectively, 71, 83, and 75%. These findings indicate that M-mode echocardiographic left atrial enlargement is a useful marker of advanced hemodynamic and angiographic abnormality in patients with coronary artery disease.