© 2015, Wiley Periodicals, Inc. DOI: 10.1111/echo.12880
Echocardiography
Right and Left Atrial Dissimilarities in Normal Subjects Explored by Speckle Tracking Echocardiography Sherif Moustafa, M.B.B.C.h.,*† Hamed Zuhairy, M.D.,† Mostafa A. Youssef, M.D.,† Nanette Alvarez, M.D.,‡ Michael S. Connelly, M.B.B.S.,‡ Timothy Prieur, M.D.,‡ and Farouk Mookadam, M.D.* *Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona; †Department of Cardiovascular Diseases, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia; and ‡Department of Cardiovascular Diseases, University of Calgary, Calgary, Alberta, Canada
Background: Atrial function is an important contributor of ventricular function and has a prognostic role in various cardiovascular diseases. We tested the hypothesis that right and left atrial (RA & LA) function may not be equal despite their accommodating identical cardiac output. Methods: Two-dimensional (2D) speckle tracking echocardiography was acquired from the apical four-chamber view in 100 normal subjects. Both RA/LA subendocardial borders were traced to obtain atrial volumes, strain (e) and strain rate (SR). Reservoir, conduit, and booster pump functions were evaluated. Consequently, eNeg (corresponding to pump function) and ePos (corresponding to conduit function) were gauged. The SR parameters (SRLateNeg, SRPos, and SREarlyNeg), corresponding respectively to atrial systole, inception of ventricular systole, and inception of ventricular diastole, were measured. Results: Mean age was 39 15 years with 50 men (50%). Volumetric indices revealed that reservoir (Filling Volume = 35.1 10.4 mL for LA vs. 27.47 11.93 mL for RA, expansion index = 52.18 16.89% for LA vs. 45.03 16.49% for RA and diastolic emptying index = 52.85 16.85 for LA vs. 45.62 16.5 for RA, P < 0.001) and conduit (passive emptying (%) of total emptying = 34.49 10.4 for LA vs. 26.82 11.98 for RA and passive emptying index = 52.63 16.86 for LA vs. 45.39 16.5 for RA, P < 0.001) functions were significantly higher in the LA compared to the RA. Nevertheless, deformation indices demonstrated an opposite pattern (SRpos = 1.88 0.74 for RA vs. 1.56 0.54 for LA, P = 0.03 and ePos = 59.56 30.63 for RA vs. 45.94 16.67 for LA, P < 0.001). Reservoir, conduit, and booster pump functions showed no statistical significance among both genders. Conclusions: Evaluation of global and regional RA/LA function by speckle tracking echocardiography is feasible. The current report provides insights regarding dissimilarities between both atria in healthy individuals. The significance of these findings and their potential application will warrant further work. (Echocardiography 2015;32:1392–1399) Key words: right atrium, left atrium, function, speckle tracking echocardiography Atrial function is an important contributor of ventricular filling and has a prognostic role in several cardiovascular diseases. Left atrial (LA) dilation is a recognized predictor of cardiac events including atrial fibrillation, heart failure, valvular disease, stroke and death.1–4 While data on the clinical influence of right atrial (RA) dilation are scarce, it has proven to be of a prognostic significance in heart failure, pulmonary hypertension, and cardiac arrhythmia.1,5–7 Speckle tracking echocardiography (STE), which tracks displacement of acoustic speckles, is Address for correspondence and reprint requests: Sherif Moustafa, M.B.B.C.h., M.S.c., M.R.C.P. (U.K.), F.A.S.E., Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA. Fax: 480 301-8018; E-mails: [email protected]; [email protected]
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a robust and a relative angle-independent technique for real time quantitative analysis of myocardial deformation. This novel method is promising for evaluating RA and LA global and regional function.2,5,8 Right- and left-sided circulations accommodate identical cardiac return and propagates identical cardiac output, in the absence of intra or extracardiac shunting. However, due to differences in pressure and resistance in between the cardiac chambers and afferent and efferent vascular attachments, RA and LA functions may have dissimilar function. Accordingly, we aimed to: (1) investigate the hypothesis that right and left atrial (RA & LA) global volumetric function might not be equal despite each accommodating identical cardiac output, (2) explore differences in deformation indices between both atria, and (3) examine the gender influence of the atria using STE.
Bi-Atrial Dissimilarities in Normal Subjects
Methods: Study Population: Between June 2013 and February 2014, 110 healthy individuals were retrospectively screened from subjects referred for an echocardiogram. Ten subjects were excluded because of suboptimal images. Indications for echocardiogram were as follows; preemployment screening (n = 87) and healthy volunteers (n = 13). All subjects had an entirely normal echocardiogram study. Inclusion criteria: (1) no history of cardiovascular disease, (2) no history of diabetes mellitus or hypertension; tobacco use; or systemic disease, (3) a body mass index ≤30 kg/m2, (4) sinus rhythm without documented arrhythmia or atrial fibrillation, (5) normal biventricular size and systolic function with no regional wall-motion abnormalities, (6) normal indexed LA volume (≤28 mL/m2 using biplane area-length method), (7) normal RA end systolic area (
Echocardiography
Right and Left Atrial Dissimilarities in Normal Subjects Explored by Speckle Tracking Echocardiography Sherif Moustafa, M.B.B.C.h.,*† Hamed Zuhairy, M.D.,† Mostafa A. Youssef, M.D.,† Nanette Alvarez, M.D.,‡ Michael S. Connelly, M.B.B.S.,‡ Timothy Prieur, M.D.,‡ and Farouk Mookadam, M.D.* *Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona; †Department of Cardiovascular Diseases, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia; and ‡Department of Cardiovascular Diseases, University of Calgary, Calgary, Alberta, Canada
Background: Atrial function is an important contributor of ventricular function and has a prognostic role in various cardiovascular diseases. We tested the hypothesis that right and left atrial (RA & LA) function may not be equal despite their accommodating identical cardiac output. Methods: Two-dimensional (2D) speckle tracking echocardiography was acquired from the apical four-chamber view in 100 normal subjects. Both RA/LA subendocardial borders were traced to obtain atrial volumes, strain (e) and strain rate (SR). Reservoir, conduit, and booster pump functions were evaluated. Consequently, eNeg (corresponding to pump function) and ePos (corresponding to conduit function) were gauged. The SR parameters (SRLateNeg, SRPos, and SREarlyNeg), corresponding respectively to atrial systole, inception of ventricular systole, and inception of ventricular diastole, were measured. Results: Mean age was 39 15 years with 50 men (50%). Volumetric indices revealed that reservoir (Filling Volume = 35.1 10.4 mL for LA vs. 27.47 11.93 mL for RA, expansion index = 52.18 16.89% for LA vs. 45.03 16.49% for RA and diastolic emptying index = 52.85 16.85 for LA vs. 45.62 16.5 for RA, P < 0.001) and conduit (passive emptying (%) of total emptying = 34.49 10.4 for LA vs. 26.82 11.98 for RA and passive emptying index = 52.63 16.86 for LA vs. 45.39 16.5 for RA, P < 0.001) functions were significantly higher in the LA compared to the RA. Nevertheless, deformation indices demonstrated an opposite pattern (SRpos = 1.88 0.74 for RA vs. 1.56 0.54 for LA, P = 0.03 and ePos = 59.56 30.63 for RA vs. 45.94 16.67 for LA, P < 0.001). Reservoir, conduit, and booster pump functions showed no statistical significance among both genders. Conclusions: Evaluation of global and regional RA/LA function by speckle tracking echocardiography is feasible. The current report provides insights regarding dissimilarities between both atria in healthy individuals. The significance of these findings and their potential application will warrant further work. (Echocardiography 2015;32:1392–1399) Key words: right atrium, left atrium, function, speckle tracking echocardiography Atrial function is an important contributor of ventricular filling and has a prognostic role in several cardiovascular diseases. Left atrial (LA) dilation is a recognized predictor of cardiac events including atrial fibrillation, heart failure, valvular disease, stroke and death.1–4 While data on the clinical influence of right atrial (RA) dilation are scarce, it has proven to be of a prognostic significance in heart failure, pulmonary hypertension, and cardiac arrhythmia.1,5–7 Speckle tracking echocardiography (STE), which tracks displacement of acoustic speckles, is Address for correspondence and reprint requests: Sherif Moustafa, M.B.B.C.h., M.S.c., M.R.C.P. (U.K.), F.A.S.E., Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA. Fax: 480 301-8018; E-mails: [email protected]; [email protected]
1392
a robust and a relative angle-independent technique for real time quantitative analysis of myocardial deformation. This novel method is promising for evaluating RA and LA global and regional function.2,5,8 Right- and left-sided circulations accommodate identical cardiac return and propagates identical cardiac output, in the absence of intra or extracardiac shunting. However, due to differences in pressure and resistance in between the cardiac chambers and afferent and efferent vascular attachments, RA and LA functions may have dissimilar function. Accordingly, we aimed to: (1) investigate the hypothesis that right and left atrial (RA & LA) global volumetric function might not be equal despite each accommodating identical cardiac output, (2) explore differences in deformation indices between both atria, and (3) examine the gender influence of the atria using STE.
Bi-Atrial Dissimilarities in Normal Subjects
Methods: Study Population: Between June 2013 and February 2014, 110 healthy individuals were retrospectively screened from subjects referred for an echocardiogram. Ten subjects were excluded because of suboptimal images. Indications for echocardiogram were as follows; preemployment screening (n = 87) and healthy volunteers (n = 13). All subjects had an entirely normal echocardiogram study. Inclusion criteria: (1) no history of cardiovascular disease, (2) no history of diabetes mellitus or hypertension; tobacco use; or systemic disease, (3) a body mass index ≤30 kg/m2, (4) sinus rhythm without documented arrhythmia or atrial fibrillation, (5) normal biventricular size and systolic function with no regional wall-motion abnormalities, (6) normal indexed LA volume (≤28 mL/m2 using biplane area-length method), (7) normal RA end systolic area (
