Echocardiographic determination of left atrial function and its application for assessment of mitral flow velocity pattern

We determined left atrial (LA) volume changes to evaluate LA function, and to correlate the Doppler-determined mitral flow velocity (MFV) pattern. Twenty-four patients with ischemic heart disease who showed ‘normal’ MFV pattern by pulsed Doppler echocardiography were studied. The patients were divided into 14 patients with left ventricular end diastolic pressure <18 mmHg (true normals) and 10 patients with ≥18 mmHg (pseudo normals). The changes in LA volume were determined by echocardiography from apical two- and four-chamber views with modified Simpson’s method. The volume measurements were done at the time of mitral valve opening (Vmax), at onset of atrial systole (Va) and at mitral valve closure (Vmin). Then the passive LA emptying volume was calculated by subtracting Va from Vmax, and the active LA emptying volume by subtracting Vmin from Va. The LA ejection fraction was calculated by the formula: {(Va−Vmin)Va}×100. There was no significant difference in LA ejection fraction in pseudo normal (39±6%) and in true normal (41±13%) patients. Although the passive LA emptying volume was 16±4 ml/beat in true normal and was 11±3 ml/beat in pseudo normal (NS), the active LA emptying volume was significantly greater in pseudo normals (22±4 m/beat) than in true normals (12±2 ml/beat, P<0.001). Thus, the ratio of passive and active LA emptying volume was markedly greater in true normals (1.28±0.35) than in pseudo normals (0.52±0.19, P<0.001), facilitating the differentiation of these two groups. These results indicate that two-dimensional echocardiographic measurement of LA volume can be valuable in assessing the LA function, providing an alternative method for differentiating pseudo normal from true normal MFV pattern in clinical settings, although several technological shortcomings should be resolved.