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Influence of left atrial pressure on left atrial appendage flow velocity patterns in patients in sinus rhythm
1Second Department of Internal Medicine, Tokushima University, School of Medicine, Japan.
Insights
Elevated left atrial pressure in patients with heart disease significantly reduces left atrial appendage blood flow velocities, increasing thrombus formation risk even during sinus rhythm.
Area of Science:
- Cardiology
- Echocardiography
- Hemodynamics
Background:
- Left atrial appendage (LAA) function is crucial for preventing thrombus formation.
- Assessing LAA flow patterns in relation to atrial pressures is important for understanding cardiovascular disease.
- Sinus rhythm patients with myocardial disease may exhibit altered LAA hemodynamics.
Purpose of the Study:
- To investigate changes in LAA flow velocity patterns during sinus rhythm.
- To correlate these changes with left atrial pressures in patients with myocardial disease.
- To compare LAA function in patients with varying levels of elevated left atrial pressure and controls.
Main Methods:
- Transesophageal echocardiography and cardiac catheterization were performed.
- 31 patients with myocardial disease in sinus rhythm and 20 controls were studied.
- Patients were stratified into high and low mean pulmonary capillary wedge pressure groups.
Main Results:
- LAA peak early emptying velocity decreased in both high and low wedge pressure groups compared to controls.
- LAA peak late emptying velocity was reduced in the high wedge pressure group but increased in the low wedge pressure group versus controls.
- Increased wedge pressure correlated negatively with LAA peak late emptying velocity and LAA ejection fraction, and positively with maximum LAA area.
- Spontaneous echo contrast and LAA thrombi were observed in the high wedge pressure group.
Conclusions:
- Marked elevation in left atrial pressure significantly reduces LAA emptying velocities, even in sinus rhythm.
- Altered LAA hemodynamics associated with elevated left atrial pressure may increase thrombus formation risk.
- These findings highlight the importance of assessing LAA function in patients with increased left atrial pressures.
Abstract:
To examine changes in left atrial appendage flow velocity patterns in relation to left atrial pressures during sinus rhythm, transesophageal echocardiography and cardiac catheterization were performed in 31 patients with myocardial diseases in sinus rhythm and 20 control subjects without cardiovascular disease. The 31 patients were divided into two groups according to mean pulmonary capillary wedge pressure: the group with high wedge pressure (19.9 +/- 5.8 mmHg) and the group with low wedge pressure (8.6 +/- 2.9 mmHg). The left atrial appendage peak early emptying velocity was decreased significantly in the groups with both high and low wedge pressure compared with the control group. The left atrial appendage peak late emptying velocity was significantly greater in the group with low wedge pressure compared with the control group, whereas it was decreased significantly in the group, with high wedge pressure compared with the control group. The left atrial appendage peak late emptying velocity had a significant negative correlation with wedge pressure. The maximum left atrial appendage area at end systole in the group with high wedge pressure was significantly greater than that in both the group with low wedge pressure and the control group. There was a significant positive correlation between the maximum left atrial appendage area and the wedge pressure, as well as a significant negative correlation between the left atrial appendage ejection fraction during atrial contraction and the wedge pressure. In the group with high wedge pressure, one patient had evidence of left atrial appendage thrombi and two had spontaneous echo contrast. These results suggest that even in patients in sinus rhythm, a marked elevation in the left atrial pressure is likely to reduce the left atrial appendage peak early and late emptying velocities. These changes may be accompanied by an increased incidence of thrombus formation in the left atrial appendage compared with individuals with normal or only slightly elevated left atrial pressures.