LEFT ATRIAL FUNCTION IN CONGESTIVE-HEART-FAILURE - ASSESSMENT BY TRANSMITRAL AND PULMONARY VEIN DOPPLER

The relation of transmitral flow patterns and pulmonary venous velocit ies was analyzed from 50 heart failure patients (28 men, 22 women; mea n [+/-SD] age 61 +/- 9 years) with a left ventricular ejection fractio n < 40%. Doppler echocardiography was performed in all patients. Trans mitral flow measurements included early CE) and atrial (A) velocities and deceleration time of E wave (DT). Patients were assigned to two gr oups according to EIA ratio, DT, or both: 20 patients in the restricti ve group, and 30 patients in the nonrestrictive group. Pulmonary venou s flow was. obtained by the transthoracic approach. Systolic (S), dias tolic (D) and atrial reversal (Ar) velocities were measured. Of the st udy population, 13 patients had simultaneously determined pulmonary ca pillary wedge pressure (PCWP). The results showed a lower S (28 +/- 11 vs. 51 +/- 10 cm/sec, p < 0.01), a higher D (66 +/- 13 vs. 44 +/- 10 cm/sec, p < 0.01) and a smaller Ar (12 +/- 10 vs. 24 +/- 9 cm/sec, p < 0.01) in the restrictive group compared with those in nonrestrictive group. In the subgroup of patients undergoing invasive hemodynamic stu dies, there was no relationship between PCWP and atrial reversal veloc ity. However, a significant correlation was observed for pulmonary sys tolic (r = -0.70, p < 0.01) and diastolic (r = 0.76, p < 0.01) velocit ies to PCWP. These findings suggest a reduction in left atrial complia nce and atrial systolic function and both play important roles in hear t failure patients with the restrictive transmitral flow pattern.