EVALUATION OF LEFT ATRIAL ACTIVE CONTRACTION AND RELAXATION IN VARIOUS MYOCARDIAL DISEASES BY TRANSESOPHAGEAL PULSED DOPPLER-ECHOCARDIOGRAPHY OF LEFT-VENTRICULAR INFLOW AND PULMONARY VENOUS FLOW

The purpose of this study was to evaluate the left atrial active contr action and relaxation in patients with various myocardial diseases by analyzing pulmonary venous flow (PVF) and left ventricular inflow (LVI F) velocity patterns, using transesophageal pulsed Doppler echocardiog raphy. We studied 60 patients with sinus rhythm (25 with hypertrophic cardiomyopathy, 15 with dilated cardiomyopathy and 20 with old myocard ial infarction) and 15 normal controls. The peak first systolic PVF ve locity (PVS1) in patients with dilated cardiomyopathy were smaller tha n those of normal controls and patients with hypertrophic cardiomyopat hy and old myocardial infarction. The peak atrial systolic LVIF (LVIF- A) and PVF (PVA) velocities and left atrial volume change during atria l contraction in hypertrophic cardiomyopathy and old myocardial infarc tion were larger than those of normal controls and patients with dilat ed cardiomyopathy. The relation between the PVS1 and the PVA shifted t oward the left and inferiorly in patients with dilated cardiomyopathy, and toward the left and superiorly in patients with hypertrophic card iomyopathy and old myocardial infarction as compared with normal contr ols. PVA and left ventricular end-diastolic pressure (LVEDP) determine d by cardiac catheterization showed no overall correlation in the 23 p atients examined, but a good positive correlation in the 15 patients w ith hypertrophic cardiomyopathy and old myocardial infarction, excludi ng the 8 with dilated cardiomyopathy. The ratio (PV-A/S-1) of the PVA to the PVS1 correlated positively with the LVEDP in all the 23 patient s. Thus, the PVS1 of PVF velocity reflects left atrial relaxation, and both the atrial systolic waves of PVA and LVIF-A velocities reflect b ooster pump function of the left atrium in addition to left ventricula r compliance at end-diastole. Conjunctional use of PVF and LVIF veloci ties can help in evaluating left atrial active contraction and relaxat ion in various myocardial diseases.