Document Detail


Relation of left atrial dysfunction to pulmonary artery hypertension in patients with aortic stenosis and left ventricular systolic dysfunction.
MedLine Citation:
PMID:  20643255     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pulmonary artery hypertension (PAH) increases mortality in patients with severe aortic stenosis. We hypothesized that left atrial (LA) dysfunction would be related to PAH in patients with severe aortic stenosis complicated by left ventricular (LV) systolic dysfunction. The data from 70 patients with severe aortic stenosis and LV systolic dysfunction were analyzed. From the transmitral flow, the peak early (E) and late (A) diastolic velocities were obtained. From the pulmonary vein flow, the peak S-wave, D-wave, and reversed atrial wave velocities were determined. The right ventricular systolic pressure was measured in 50 patients and averaged 38 +/- 13 mm Hg. Patients with PAH (n = 19) presented with greater LV diameters, E/A ratio, E-wave velocity, LV mass index, reversed atrial wave velocity, and LA volume (p <0.05) and lower S/D ratio and total and active LA emptying fractions (p <0.05). Simple linear regression analysis revealed that the LA volumes and total and active LA emptying fractions displayed the strongest correlations with the right ventricular systolic pressure. Multiple regression analysis revealed that the minimum LA volume (r = 0.61, p = 0.0001) independently correlated with the right ventricular systolic pressure, irrespective of the aortic valve (AV) area or gradient. In patients who underwent an echocardiographic examination >or=1 month after AV replacement, LA function had improved significantly. The degree of improvement was related to the degree of recovery of the LV diastolic function and diameter. In conclusion, in patients with severe aortic stenosis and concomitant LV systolic dysfunction, the LA function parameters displayed the strongest correlations with the right ventricular systolic pressure, irrespective of the AV area or gradient and were impaired in patients with PAH. LA function recovered after AV replacement. Additional studies are warranted to determine the prognostic significance of LA function in this setting.
Authors:
Roberto M Saraiva; Yoshiki Matsumura; Tetsuhiro Yamano; Neil Greenberg; James D Thomas; Takahiro Shiota
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2010-06-18
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-20     Completed Date:  2010-08-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  409-16     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve Stenosis / physiopathology*,  ultrasonography
Blood Flow Velocity
Echocardiography
Electrocardiography
Female
Heart Atria / physiopathology*,  ultrasonography
Humans
Hypertension, Pulmonary / physiopathology*,  ultrasonography
Linear Models
Male
Stroke Volume
Systole
Ventricular Dysfunction, Left / physiopathology*,  ultrasonography

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