A new method for the evaluation of atrial function: transthoracic tissue Doppler echocardiography
description
Transcript of A new method for the evaluation of atrial function: transthoracic tissue Doppler echocardiography
Department of
Cardiology
KULeuvenUZ Gasthuisberg
University Hospital Gasthuisberg, Leuven, BELGIUM
A new method for the
evaluation of atrial
function: transthoracic
tissue Doppler
echocardiography
Department of
Cardiology
KULeuvenUZ Gasthuisberg
University Hospital Gasthuisberg, Leuven, BELGIUM
T. Palecek, V.
Dambrauskaite, E. Eroglu, S.
Langeland, J. D
´hooge, P. Claus,
B. Bijnens, G. R. Sutherland
KULeuven, Cardiology
Atrial Function
Hemodynamic function of the atria – 3 phases:
Booster pumpActive atrial emptying, followed by atrial relaxation
ReservoirDuring ventricular systole, storing blood and energy
Conduit
During rapid ventricular filling, passive emptying of the atria, followed by plateau (diastasis)
KULeuven, Cardiology
Echocardiographic Evaluation of Atrial Function
Various parameters derived from M-mode, 2D-grey scale and blood pool Doppler echocardiography proposed:
Atrial diameters, areas, volumes emptying fractions and volumes, ejection fraction, expansion index
Transmitral and pulmonary vein flow variables velocity ratios, atrial kinetic energy
However, the assessment of atrial function still remains a diagnostic challenge
KULeuven, Cardiology
Tissue Doppler Echocardiography
(TDE)
• A recently developed ultrasonic technique allowing quantitative analysis of myocardial velocities
• TDE evaluation of ventricular function has been largely documented
• TDE by measuring atrial velocities could also quantify atrial function
KULeuven, Cardiology
The Aim of the Study
• Feasibility study
• To define normal atrial radial velocity profiles
and determine the potential clinical role of
transthoracic TDE in assessing atrial function
KULeuven, Cardiology
Methods
• 10 young healthy subjects (31±4 years, 8 males)Sinus rhythm
Normal standard echocardiographic examination
• To determine normal radial velocity profiles, pulsed wave TDE recordings (sample volume 5-10mm) of left and right atrial superior wall motion were performed
Left atrial superior wall motion recorded in apical 4-chamber (A4C) and 2-chamber (A2C) views
Right atrial superior wall motion recorded in A4C and parasternal short axis (SAx) views
KULeuven, Cardiology
Atrial Radial Velocities
Atrial contraction
Atrial relaxation
Passive forward motion during ventricular
contraction
Left Atrium
Right Atrium
Passive backward motion during rapid ventricular filling
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Peak Atrial Radial Contraction (AC)
and Relaxation (AR) Velocities
Left Atrium
Right Atrium
AC Vel(m.s-1)
AR Vel(m.s-1)
AC Vel(m.s-1)
AR Vel(m.s-1)
A4CA2C
A4CSAx
0,06±0,01**0,06±0,02**
0,04±0,01*0,05±0,01*
0,04±0,010,04±0,01
0,03±0,010,03±0,01
* p < 0,01 for the difference between left and right AR velocities
** p < 0,001 for the difference between left and right AC velocities
KULeuven, Cardiology
Correlation between Peak AC and AR Radial Velocities
Left AC vs. AR velocitiesAR = ,00355 + ,69798 * AC
Correlation: r = ,85385
0,03 0,04 0,05 0,06 0,07 0,08 0,09 0,10
Left AC velocities
0,025
0,030
0,035
0,040
0,045
0,050
0,055
0,060
0,065
0,070
0,075
Left
AR v
eloc
ities
Right AC vs. AR velocitiesAR = ,00859 + ,58549 * AC
Correlation: r = ,79379
0,01 0,02 0,03 0,04 0,05 0,06 0,07 0,08
Right AC velocities
0,015
0,020
0,025
0,030
0,035
0,040
0,045
0,050
0,055
Rig
ht A
R v
eloc
ities
KULeuven, Cardiology
Conclusions
• In normal subjects, AC and AR radial velocities from both atria could be consistently and reproducibly recorded.
• Left AC and AR radial velocities were higher then their right atrial equivalents.
• The values of AR velocities strongly correlated with the values of AC velocities.
• Tissue Doppler indices represent a promising new method to investigate atrial function.