Is mitral annular ascent useful in studying left ventricular function through left atrio-ventricular interactions?

Background The mitral annulus (MA) is a crucial structure that is in constant motion throughout the cardiac cycle. The main purpose of this study was to determine if M-mode evaluation of the longitudinal motion of the MA could be useful to examine atrio-ventricular interactions. Methods Echocardiographic data obtained from 150 patients (mean age 56 ± 16; 82 males) from the University of Cincinnati College of Medicine was evaluated to examine if any relationship exists between MA motion and measures of atrio-ventricular interactions. Results Even though left atrial size, left ventricular (LV) mass index, LV ejection fraction (LVEF) and degree of LV diastolic dysfunction (LVDD) were significant echocardiographic variables affecting MA motion; LVEF and the degree of LVDD were the main determinants of MA excursion during systole (MAPSE) and after atrial contraction (MAa). Our results confirm the surrogate value of MAPSE with regards to LVEF and also show that the extent of MA excursion during systole is the main determinant of MAa. The effect of LV diastolic function applies more strongly to MAPSE than to MAa. However, the maximal MAa amplitude varies in accordance to the type of LVDD. Conclusions We have shown for the first time that M-mode interrogation of the MA longitudinal motion appears useful to assess atrio-ventricular interactions. Since LV systolic and diastolic functions are so closely related; additional studies are now required to examine how this longitudinal measure correlates with known circumferential rotational data obtained with other imaging modalities.

Assessment for left atrial size by echocardiographic left atrial dimensional index / 中华超声影像学杂志

Objective To investigate the diagnostic value of echocardiographic left atrial dimensional index( LADi) for evaluating left atrial size . Methods One hundred and eleven subjects were divided into left atrial enlarged group( n = 53) and left atrial normal group( n = 58) by the left atrial volume index( LAVi) with cutoff value of 34 ml/ m 2 . Left atrial antero-posterior diameter ( D1) ,medial-later diameter ( D2) , superior-inferior diameter ( D3 ) were measured ,and the average value ( D ) was calculated . Left atrial dimensional index( LADi) were calculated as D divided by body surface area (BSA) . Left atrial volume was measured using the biplane Simpson method ,and LAVi was calculated . Based on LAVi as reference standards ,inter-observer variability and diagnostic value of these parameters were analyzed . Results There were differences in the measured parameters between the two groups . In the left atrial enlarged group and normal group ,LADi had good correlation with LAVi ( left atrial enlargement group : r = 0 .87 ;normal control group : r = 0 .80) . LADi had the best diagnostic accuracy ,area under curve( AUC) was 0 .95 ,and the cutoff value of LADi to diagnosing left atrial enlarged was 26 .4 mm / m 2 . D ,LADi and D1 showed good inter-observer agreement ,intraclass correlation coefficient( ICC) was 0 .94 .Conclusions LADi may become a new method in evaluating left atrial size with its accuracy and efficiency .

Remodelado auricular adverso en atletas de alto rendimiento: Estudio de deformación auricular con speckle tracking 2D / Adverse left atrial remodeling in highly trained athletes: an echocardiography study using 2D speckle tracking

Background: Highly trained athletes are at increased risk of atrial fibrillation (AF) and flutter. Atrial dilatation and dysfunction might be the underlying substrate for the increased risk. The aim of the present study was to relate atrial size and deformation in a selected group of highly trained athletes and patients with paroxysmal atrial fibrillation (PAF). Methods: 20 professional male hand-ball players, 18 patients with PAF and 20 healthy age-matched, non-sportive males were compared. All subjects underwent a transthoracic echocardiogram with evaluation of left atrial (LA) dimensions. Left atrial strain (LASa) and strain rate (LASRa) derived from speckle tracking were used to evaluate LA deformation post atrial contraction. Results: LA volumes were significantly larger in athletes and PAF patients compared to controls (36 + 1.7 ml/m2; 36 ± 2.3 ml/m2 and 24 + 1 ml/m2, respectively, p < 0.01;). LASa and LASRa during active atrial contraction were decreased in PAF patients compared to athletes and controls (-10.6 ± 0.2 %; -12.2 ± 0.4 % and -14.5 ± 0.5 %, p < 0.01 for LASa and -1.2 ± 0.08 sec-1; -1.5 ± 0.12 sec-1; -1.7 ± 0.13 sec-1, p= 0.04 for LASRa respectively). Athletes with LA volume > 40 ml/m2 (n=7) showed reduced LASa compared to athletes with LA volume < 40 mL/m2 (-10.3 ± 0.4% versus -13.0 ± 0.5%, p < 0.01). PAF patients had LASa values similar to those of subjects with normal LA volume. Conclusion: Athletes with increased LA volume exhibit lower strain parameters compared to subjects with PAF. It is postulated that measurement of LA strain may be used to predict development of AF in highly trained athletes.

Introducción: Atletas de alto rendimiento tienen un riesgo aumentado de desarrollar fibrilacion auricular (FA) y flutter. La dilatación y disfunción auricular podrían ser el sustrato subyacente para este incremento en el riesgo. El objetivo fue analizar y relacionar el tamaño y deformación auricular en un grupo seleccionado de atletas y en pacientes con FA paroxística. Métodos: Se incluyeron 20 jugadores de balón-mano profesionales y 20 controles sedentarios, pareados por edad y sexo, junto a 18 pacientes con FA paroxística. En todos los sujetos se realizó un estudio ecocardiográfico bidimensional con evaluación de las dimensiones y de la deformación (post contracción auricular) por strain (Sa) y strain rate (SRa) de la aurícula izquierda (AI). Resultados: El volumen AI fue significativamente mayor en atletas y pacientes con FA respecto de los controles (36 + 1,7 ml/m2; 36 ± 2,3 ml/m2 y 24 + 1 ml/m2, p < 0,01; respectivamente). El SaAI y SRaAI durante la contracción auricular estaban disminuidos en los pacientes con FA paroxística respecto de atletas y controles (-10,6 ± 0,2 %; -12,2 ± 0,4 % y -14,5 ± 0,5 %, p < 0,01 para SaAI y -1,2 ± 0,08 sec-1; -1,5 ± 0,12 sec-1; -1,7 ± 0,13 sec-1, p= 0,04 para SRaAI, respectivamente). Los atletas con un volumen AI > 40 ml/m2 (n=7) mostraron valores reducidos de SaAI comparados con atletas con un volumen AI < 40 mL/m2 (-10,3 ± 0,4% versus -13,0 ± 0,5%, p < 0,01) y éstos fueron similares a los pacientes con FA (-10,3 ± 0,4% versus -10,6 ± 0,2%, p= 0,6). Conclusiones: Una proporción de atletas con dilatación AI presentan evidencia de disfunción contráctil de la AI, caracterizado por valores de strain disminuidos que son similares a los de pacientes con FA paroxística. Esto podría corresponder a un sustrato para el desarrollo posterior de arritmias auriculares en estos atletas.

Effects of berberine on left atria and trachea in guinea pigs / 中国临床药理学与治疗学

AIM: To observe the effects of berberine (Ber) on left atria and trachea in guinea pigs. METHODS: The experiment was carried out with isolated left atria and trachea in guinea pigs, and the effects and interactions were compared between Ber and pinacidil (Pin). RESULTS: Ber concentration-dependent increased the force of contractile, while Pin decreased the force. Ber leaded a parallel rightward shift in accumulated response curve of depression contraction of left atria by Car, and it hardly changed the maximum response (E_(max)), while Pin leaded a parallel leftward shift in the same curve. In the combination of Ber and Pin, the dose-response curve hardly changed as the control one. In isolated guinea pig trachea, Ber caused a leftward shift in the dose-response curve of ACh, whereas Pin produced a rightward shift in the same curve without changing E_(max). When both Ber and Pin existed in the same container, there was no modification in the response to ACh. CONCLUSION: Ber shows the effect of blocking potassium channel.

The Relationship of Left Atrial Size of Rheumatic Heart Disease to Myocardial Pathology and Its Clinical Implications / 第二军医大学学报

The relation between left atrial (LA) size and myocardial pathological changes, and clinical implications were studied in 25 patients with- rheumatic mitral stenosis. The results showed that LA size was significantly correlated with pathological severity of myocardium (P 100 ml/m2 and accompanied by moderate or severe pathological changes easily suffered from Af (P200ml/m2 and severe pathological changes. The results suggest that occurence of Af may be predicated based on the LA volume and Af cardioversion should be selectively performed to obtain better results.