-511- ANALYSIS OF THE ROLE OF LEFT ATRIAL PRESSURE IN THE REGULATION OF LEFT VENTRICULAR RAPID FILLING IN THE DOG
Takatoshi MochizukiMasahiko IizukaToshiyuki TakahashiHiroshi SatoTetsuo OhyaTeruhiko AoyagiJe-Xin MaTakashi SerizawaTsuneaki Sugimoto
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Left atrial pressure
Ventricular filling
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It is well known, that the left atrium plays an important role in filling of the left ventricle: In first instance by being a reservoir of expansion during systole, than by being a conduit phase during diastole and finally by an active phase (if sinus rhythm is present) during late diastole [1]. This active phase has an important role in compensation of decreased left ventricular compliance in patients with heart failure. It is well known, that cardiac output decreases with 15–20% in patients who are in atrial fibrillation or are only paced in the ventricle [2]. This is not only of importance from pathophysiological point of view, but left atrial function is also an independent determinant of prognosis in patients with heart failure [3]. Stretch of the left atrium is generally controlled by intra-atrial pressure. The Frank–Starling mechanism of the left atrium can be described by a biphasic increase of contraction force after increase of the stretch level.
Left atrial function has been investigated with echocardiography for a long time [4].
One can make simple measurements of left atrial size or left atrial volume but also try to quantify left atrial function with Doppler and tissue Doppler. During heart failure, atrial function is characterised by augmented reservoir and pump function. This can be measured with pulsed wave Doppler across the mitral valve, which is generally expressed by a decreased E/A ratio. However, there is a marked heterogeneity among heart failure patients with pseudo normal patterns and restrictive filling patterns. This makes it difficult to use pulsed wave Doppler as a determinant of prognosis and guide therapy. The current paper of Tripokiadis et al. [5], describes the measurement of left atrial ejection volume and left atrial ejection force in patients with heart failure. The method is not new and has been described in normal volunteers and patients with atrial fibrillation [6]. Although there were some limitations of the study in sample size, matching of age groups and gender, the authors were able to demonstrate, that left atrial function increases during heart failure and so compensated the decrease of left ventricular function. The model, described by Tripokiadis et al. can be used to estimate atrial function in patients with systolic and diastolic left ventricular dysfunction but also to evaluate the influence of atrial contribution to ventricular filling after medical treatment. Doing so, individual treatment can be optimised not only taking into account the clinical status, renal status, ventricular remodelling and neurohormonal status (BNP), but also atrial contribution to left ventricular filling.
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Conference Abstract| January 01 1987 Increased Left Ventricular Filling following Atrial Contraction in Hypertension N. Benjamin; N. Benjamin 1Department of Medicine, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE Search for other works by this author on: This Site PubMed Google Scholar B.F. Robinson B.F. Robinson 1Department of Medicine, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1987) 72 (s16): 61P. https://doi.org/10.1042/cs072061P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation N. Benjamin, B.F. Robinson; Increased Left Ventricular Filling following Atrial Contraction in Hypertension. Clin Sci (Lond) 1 January 1987; 72 (s16): 61P. doi: https://doi.org/10.1042/cs072061P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu nav search search input Search input auto suggest search filter All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1987 The Biochemical Society and the Medical Research Society1987 Article PDF first page preview Close Modal You do not currently have access to this content.
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The full left atrium function is essential to maintain the left ventricular force in hypertension patients.The left atrium is involved in three functions: conserving,piping and sub-pumping.Hypertension tends to increase left atrial volume and systolic pumping but decrease its passive emptying.Age,left ventricular mass index,left ventricular remodelling and the left atrial prosystolic volume index are important factors which influence the left atrial ejection fraction.This article assesses left atrial function,which can lead to earlier diagnosis of left ventricular dysfunction.
Atrium (architecture)
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Left atrial pressure
Atrium (architecture)
Biplane
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Left atrial enlargement
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The relationship of left atrial contraction to ventricular filling was studied in 24 patients. Eight patients had aortic stenosis, eight had mitral stenosis, and eight others served as a control group. All had normal sinus rhythm. Cineangiocardiographic volumetric determinations of the left ventricle were done throughout the cardiac cycle, and the rate of left ventricular filling before and during left atrial contraction was calculated. In the group with aortic stenosis 39% of the left ventricular stroke volume entered the ventricle during left atrial contraction; in the group with mitral stenosis 24% was contributed during left atrial contraction, and in the control patients, 26%. The rate of left ventricular filling more than doubled during left atrial contraction in aortic stenosis, while no consistent change in the rate of filling occurred during left atrial contraction in mitral stenosis and in the control group. The character of the resistance to left ventricular filling in aortic stenosis and mitral stenosis is discussed. An important contribution by left atrial contraction to left ventricular performance in aortic stenosis is suggested.
Cardiac cycle
Mitral valve stenosis
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Ventricular Function
Left Ventricular Thrombus
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Left atrial enlargement
Ventricular Function
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