Decreased left atrial appendage function is an important predictor of elevated left ventricular filling pressure in patients with congestive heart failure

Objective: The aim of this study was to investigate whether left atrial (LA ) appendage function, as indicated by LA appendage blood flow velocities an d its ejection fraction, could identify elevated left ventricular filling p ressure in patients with chronic congestive heart failure. Methods: Using t ransesophageal echocardiography, adequate pulsed Doppler LA appendage activ e emptying and filling velocities could be recorded in 25 consecutive patie nts (16 men and 9 women, aged 57+/-10 years) with chronic congestive heart failure (symptom duration greater than or equal to 1 year). LA appendage ej ection fraction calculated as (LA appendage maximal area)-(LA appendage min imal area)/(LA appendage maximal area)X100 was also determined in these pat ients. Left ventricular end-diastolic pressure was recorded during cardiac catheterization performed within 24 h of echocardiographic study. Results: Left ventricular end-diastolic pressure was 2 to 47 mm Hg. There were close negative correlations of LA appendage emptying velocity (r=-0.508; P<0.01) , filling velocity (r=-0.429; P<0.05) and LA appendage ejection fraction (r =-0.523; P<0.005) with left ventricular end-diastolic pressure. LA appendag e active emptying velocity <30 cm/s predicted left ventricular end-diastoli c pressure >25 mm Hg with a sensitivity of 72.7%, a specificity of 92.9% an d a positive and negative predictive value of 88.9 and 81.3%. Conclusions: The findings suggest that measurement of LA appendage blood flow velocities and contractile function by transesophageal echocardiography can be used t o predict elevated left ventricular filling pressure in patients with conge stive heart failure. (C) 1999 Elsevier Science Ireland Ltd. All rights rese rved.