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Echocardiographic Assessment of Left Atrial Systolic Function after Percutaneous Mitral Balloon Valvuloplasty Using Tissue Doppler Imaging

Hasan MN, Banarjee SK, Ahsan SA, Habib SM, Mahmood M

Mymensingh Med J, 2018 Oct;27(4):851-858.
PMID: 30487504

Mitral stenosis (MS) affects left atrial (LA) function as a result of hemodynamic and myocardial factors that causes significant symptoms and complications. Conventional echocardiographic methods have been practicing to see the improvement of left atrial function after successful percutaneous mitral balloon valvuloplasty (PMBV). Introduction of tissue doppler imaging allows direct and non-invasive measurement of myocardial velocities. The aim of the study was to evaluate LA functions after PMBV using colour tissue doppler imaging. This cross sectional study was performed in Cardiology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2014 to February 2015. Forty six (46) patients (28 females, mean age: 28.96±5.78 years) presenting with mitral valve stenosis who fulfilled the indications for PMBV were included in the study. Within 24 hours before PMBV, all the patients underwent colour tissue doppler study in addition to routine conventional echocardiographic examinations. Late diastolic velocities (A') measured at the septal and lateral annuli were recorded. All the measurements were repeated 24 hours after PMBV. The PMBV was done using the Inoue technique. After PMBV mitral valve areas (MVA) were significantly increased. Maximum and mean gradients, LA diameter, LA area, LA volume, systolic pulmonary arterial pressure and mean LA pressures were decreased while septal and lateral A' were significantly (p<0.001) increased. Lateral and septal A' velocities were correlated with MVA and inversely related to LA pressure measured invasively during PMBV. Tissue doppler velocities illustrated improvement of left atrial systolic function after PMBV in relation to decreased mean left atrial pressure and increased mitral valve area. Therefore, tissue doppler Imaging is a useful tool to detect improvement of left atrial systolic function after PMBV in patients with mitral stenosis.

Matched MeSH terms: Atrial Function, Left
Left atrial strain: a multi-modality, multi-vendor comparison study

Pathan F, Zainal Abidin HA, Vo QH, Zhou H, D'Angelo T, Elen E, et al.

Eur Heart J Cardiovasc Imaging, 2021 01 01;22(1):102-110.
PMID: 31848575 DOI: 10.1093/ehjci/jez303

AIMS: Left atrial (LA) strain is a prognostic biomarker with utility across a spectrum of acute and chronic cardiovascular pathologies. There are limited data on intervendor differences and no data on intermodality differences for LA strain. We sought to compare the intervendor and intermodality differences between transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) derived LA strain. We hypothesized that various components of atrial strain would show good intervendor and intermodality correlation but that there would be systematic differences between vendors and modalities.
METHODS AND RESULTS: We evaluated 54 subjects (43 patients with a clinical indication for CMR and 11 healthy volunteers) in a study comparing TTE- and CMR-derived LA reservoir strain (ƐR), conduit strain (ƐCD), and contractile strain (ƐCT). The LA strain components were evaluated using four dedicated types of post-processing software. We evaluated the correlation and systematic bias between modalities and within each modality. Intervendor and intermodality correlation was: ƐR [intraclass correlation coefficient (ICC 0.64-0.90)], ƐCD (ICC 0.62-0.89), and ƐCT (ICC 0.58-0.77). There was evidence of systematic bias between vendors and modalities with mean differences ranging from (3.1-12.2%) for ƐR, ƐCD (1.6-8.6%), and ƐCT (0.3-3.6%). Reproducibility analysis revealed intraobserver coefficient of variance (COV) of 6.5-14.6% and interobserver COV of 9.9-18.7%.
CONCLUSION: Vendor derived ƐR, ƐCD, and ƐCT demonstrates modest to excellent intervendor and intermodality correlation depending on strain component examined. There are systematic differences in measurements depending on modality and vendor. These differences may be addressed by future studies, which, examine calibration of LA geometry/higher frame rate imaging, semi-quantitative approaches, and improvements in reproducibility.

Matched MeSH terms: Atrial Function, Left/physiology*
Left atrial volume index is an independent predictor of major adverse cardiovascular events in acute coronary syndrome

Gunasekaran R, Maskon O, Hassan HH, Safian N, Sakthiswary R

Can J Cardiol, 2012 Sep-Oct;28(5):561-6.
PMID: 22560463 DOI: 10.1016/j.cjca.2012.02.015

Left atrial volume index (LAVI) is well proven to be a reliable method of determining left atrial size, which has prognostic implications in cardiovascular diseases. Studies demonstrate that increased LAVI is a predictor of mortality in myocardial infarction, but its association with other major adverse cardiovascular events (MACEs) among patients post acute coronary syndrome (ACS) has not been adequately evaluated.

Matched MeSH terms: Atrial Function, Left/physiology

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