LA Function analysis Marcia Barbosa Vice Presidente - Brazilian Soc of Cardiology President-elect - Interamerican Soc of Cardiology

Transcription

1 LA Function analysis Marcia Barbosa Vice Presidente - Brazilian Soc of Cardiology President-elect - Interamerican Soc of Cardiology Belo Horizonte Brazil

2 DECLARATION OF CONFLICT OF INTEREST Nothing to disclose

3 LA Involvement Cardiovascular Disease Atrial Remodelling Diastolic Dysfunction

4 Diastolic function and LAV Doppler diastolic parameters are influenced by pre and afterload Complex interaction between LV compliance and filling pressures that affets the LA. LAV Stable indicator of diastolic function Express the duration and the severity of diastolic dysfunction Prognostic value

5 Measements of the LA r=0.78 Indexed LAV M-mode Diameter r=0.48 Tsang et al, Am J Cardiol 2002; 90:

6 LA Volume Biplane Area-Length Method LA volume = (0.85) x (A1)x(A2) L

7 LAV Comparasion of Methods n = 631 patients A-Biplanar Simpson Biplanar Prolate-elipsoid 39 ± 14 ml/m 2 38 ± 13 ml/m 2 32 ± 14 ml/m 2 Ujino et al, Am J Cardiol, 2006;98:1185

8 LA Volume Index (ml/m²) J Am Soc Echocardiogr 2005;18:

9 LAV and Diastolic Dysfunction LAV 32 ml/m2 Specificity = 100% Sensitivity = 67% Tsang et al, Am J Cardiol 2002; 90:

10 Correlation - LAV and E/e r = 0.52 p<0.001 Tsang et al, Am J Cardiol 2002; 90:

11 Indexed LAV Atrial remodelling evaluated by LAV is strongly associated with DD LAVi: less sensitive to evaluate mild and moderate diastolic dysfunction Early CV risk factor marker LAVi in dilated cardiomyopathy is associated with ventricular remodelling, DD and the degree of MR JACC 2002; 40: and JACC 2005; 45:87-92

12 LAV Atrial remodelling is influenced by several factors DD in LA pressure to keep adequate LV filling Atrial myocardial dilation and stretching LAV reflects chronic exposure of the LA to diastolic dysfunction and to LV filling pressures

13 Normal < 28 ml/m² Mild dilation: ml/m² Moderate dilation: ml/m² Severe dilation 40 ml/m²

14 LAV - Survival predictor post MI (n=341 pts) Moller et al, Circulation 2003; 107:

15 LAV and MI mortality Beinart et al, JACC 2003

16 LAV Prognosis in Chagas Disease Mortality x LAV Survival x LAV Nunes MCP, Barbosa MM. et al. J Am Soc Echo 2009;22:82-8

17 LAV in Atrial Fibrillation LAV does not increase with age. LAV: morphophysiologial expression of chronic diastolic dysfunction LAV: strong predictor of AF and stroke in the community Stronger mortality predictor than EF in MI and dilated cardiomyopathy. Osranek et al, Eur Heart J, 2005:26:2556

18 LAV Better indicator of LA size Strong predictor of AF CV risk indicator, additional to diastolic dysfunction Relation to mortality in DC, HF, MI and in mitral and aortic valvular surgery Mortality predictor in the general population Abhayaratna et al, JACC 2006; 47:

19 LA function Reservoir Contractile Function Conductor

20 Systolic Strain and Strain Rate During ventricular systole, the atria function as a reservoir to store blood when AV valves are closed Reservoir function is influence by: atrial relaxation ventric contraction due to basal displacement atrial rigid restriction Di Salvo et al. Circulation 2005:112:387-95

21 LA Function Mechanical atrial function : difficult to evaluate Doppler velocity: more dependent on AV pressure gradient than on intrinsic atrial contractility TDI, Strain Rate (SR) and Strain: new methods that seem to allow for evaluation of the atrial function

22 Strain and Strain Rate LA evaluation Atrial function in early diastole strongly influenced by LV compliance Atrial systolic Strain and Strain Rate easier to evaluate and less variable Atrial function as a reservoir during ventricular systole Peak systolic Strain and Strain Rate measure atrial reservoir function Di Salvo et al. Circulation 2005:112:387-95

23 Atrial Strain

24 Atrial Strain Rate

25 Atrial Strain Rate Atrial SR was associated with LA, aging and LV diastolic dysfunction SR in AF abnormal passive atrial streching SR may be useful in detecting LA dysfunction due to age and LA Inaba et al JASE 2005; 18:729-36

26 Atrial Strain Rate passive atrial SR and LA failure of cardioversion or early recurrence of AF SR atrial remodelling with compliance of the LA Wang et al Int J Cardiol 2006; 114:

27 LA Function in healthy ageing Physiological ageing changes in atrial myocardium as a consequence of LV diastolic dysfunction Significant reduction in global systolic strian from the 6th decade, in conjunction with age-related changes in ventricular diastolic function Atrial strain rate is a sensitive measure of alterations in atrial phasic function even in healthy ageing Boyd et al, Heart 2011 (on line)

28 LA Function in DC Contractile component, reservoir and conductor function S and SR peak values occur during the late reservoir period during ventricular systole influenced by ventricular systole Atrial peak S and SR: estimate reservoir function their measurements evaluate the influence of LV hemodynamic compromise in the LA

29 Atrial Strain - Chagas x IDC (n= 71 pts) Echo Data Chagas DCM p EF (%) 33.8 ± ± LVd mm 65.8 ± ± ,.52 LVs mm 54.9 ± ± ilav ml/m 2 50,6 ± 23, ± E/e 15,. ± ± atrial septal S 25.2 ± ± atrial septal SR 1,3 ± 0,7 1.5 ± Inferior atrial S 26,.6 ± ± Inferior atrial SR 1.4 ± ± S AD 43,.7± ± MM Barbosa et al, Eur J Echo 2011

30 LA Function LAV is the most robust index Future studies necessary to: Establish natural history in LA remodelling. Extension of the reversebility of the in LA with medical treatment. Long-term impact of these changes Accuracy of the new techniques Strain and Strain Rate to evaluate LA

31 Thank you!