Department of

Cardiology

KULeuvenUZ Gasthuisberg

University Hospital Gasthuisberg, Leuven, BELGIUM

A new method for the

evaluation of atrial

function: transthoracic

tissue Doppler

echocardiography

Department of

Cardiology

KULeuvenUZ Gasthuisberg

University Hospital Gasthuisberg, Leuven, BELGIUM

T. Palecek, V.

Dambrauskaite, E. Eroglu, S.

Langeland, J. D

´hooge, P. Claus,

B. Bijnens, G. R. Sutherland

KULeuven, Cardiology

Atrial Function

Hemodynamic function of the atria – 3 phases:

Booster pumpActive atrial emptying, followed by atrial relaxation

ReservoirDuring ventricular systole, storing blood and energy

Conduit

During rapid ventricular filling, passive emptying of the atria, followed by plateau (diastasis)

KULeuven, Cardiology

Echocardiographic Evaluation of Atrial Function

Various parameters derived from M-mode, 2D-grey scale and blood pool Doppler echocardiography proposed:

Atrial diameters, areas, volumes emptying fractions and volumes, ejection fraction, expansion index

Transmitral and pulmonary vein flow variables velocity ratios, atrial kinetic energy

However, the assessment of atrial function still remains a diagnostic challenge

KULeuven, Cardiology

Tissue Doppler Echocardiography

(TDE)

• A recently developed ultrasonic technique allowing quantitative analysis of myocardial velocities

• TDE evaluation of ventricular function has been largely documented

• TDE by measuring atrial velocities could also quantify atrial function

KULeuven, Cardiology

The Aim of the Study

• Feasibility study

• To define normal atrial radial velocity profiles

and determine the potential clinical role of

transthoracic TDE in assessing atrial function

KULeuven, Cardiology

Methods

• 10 young healthy subjects (31±4 years, 8 males)Sinus rhythm

Normal standard echocardiographic examination

• To determine normal radial velocity profiles, pulsed wave TDE recordings (sample volume 5-10mm) of left and right atrial superior wall motion were performed

Left atrial superior wall motion recorded in apical 4-chamber (A4C) and 2-chamber (A2C) views

Right atrial superior wall motion recorded in A4C and parasternal short axis (SAx) views

KULeuven, Cardiology

Atrial Radial Velocities

Atrial contraction

Atrial relaxation

Passive forward motion during ventricular

contraction

Left Atrium

Right Atrium

Passive backward motion during rapid ventricular filling

KULeuven, Cardiology

Peak Atrial Radial Contraction (AC)

and Relaxation (AR) Velocities

Left Atrium

Right Atrium

AC Vel(m.s-1)

AR Vel(m.s-1)

AC Vel(m.s-1)

AR Vel(m.s-1)

A4CA2C

A4CSAx

0,06±0,01**0,06±0,02**

0,04±0,01*0,05±0,01*

0,04±0,010,04±0,01

0,03±0,010,03±0,01

* p < 0,01 for the difference between left and right AR velocities

** p < 0,001 for the difference between left and right AC velocities

KULeuven, Cardiology

Correlation between Peak AC and AR Radial Velocities

Left AC vs. AR velocitiesAR = ,00355 + ,69798 * AC

Correlation: r = ,85385

0,03 0,04 0,05 0,06 0,07 0,08 0,09 0,10

Left AC velocities

0,025

0,030

0,035

0,040

0,045

0,050

0,055

0,060

0,065

0,070

0,075

Left

AR v

eloc

ities

Right AC vs. AR velocitiesAR = ,00859 + ,58549 * AC

Correlation: r = ,79379

0,01 0,02 0,03 0,04 0,05 0,06 0,07 0,08

Right AC velocities

0,015

0,020

0,025

0,030

0,035

0,040

0,045

0,050

0,055

Rig

ht A

R v

eloc

ities

KULeuven, Cardiology

Conclusions

• In normal subjects, AC and AR radial velocities from both atria could be consistently and reproducibly recorded.

• Left AC and AR radial velocities were higher then their right atrial equivalents.

• The values of AR velocities strongly correlated with the values of AC velocities.

• Tissue Doppler indices represent a promising new method to investigate atrial function.