International journal of cardiology · 2009
Atrial interaction in the form of 'cross talk' in patients with ventricular outflow tract obstruction.
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Henein Mark, Lam Yat-Yin, Waldenstöm Anders, Henein Michael Y
Аннотация
BACKGROUND: The Bernheim 'a' wave in the jugular venous pulse of patients with left ventricular hypertrophy has been shown to reflect accentuated right atrial activity.
OBJECTIVE: To study possible atrial interaction in patients with right and left ventricular outflow tract obstruction due to significant pulmonary (PS) and aortic valvular stenosis (AS) respectively.
METHODS: We studied 41 PS patients (age 36 ± 10 year) and 41 AS patients (age 35 ± 12 year) and their results were compared with those of 27 controls (age 30 ± 7 year). RV and LV filling were recorded by conventional PW Doppler. Biventricular segmental function was studied using the PW tissue Doppler imaging (TDI) and M-mode techniques.
RESULTS: The 2 patient groups had similar degree of ventricular outflow tract obstruction. Long axis function was impaired while global systolic function was preserved in the pressure-overloaded ventricle. Patients had higher peak late filling (A wave) and TDI late diastolic (Aa) velocities recorded in the disease-free ventricles despite having similar peak early filling velocities (E wave), E wave deceleration time and E/Ea ratios were not different from controls (p > 0.05 for all). Such accentuation of atrial activity (A wave) was moderately correlated with the degree of contralateral ventricular outflow tract obstruction (p < 0.001 for both).
CONCLUSIONS: Long axis function is more sensitive than global function in revealing myocardial dysfunction in the pressure-overloaded ventricles. The increased contralateral atrial systolic activity suggests an evidence for atrial interaction in the form of 'cross talk'.
OBJECTIVE: To study possible atrial interaction in patients with right and left ventricular outflow tract obstruction due to significant pulmonary (PS) and aortic valvular stenosis (AS) respectively.
METHODS: We studied 41 PS patients (age 36 ± 10 year) and 41 AS patients (age 35 ± 12 year) and their results were compared with those of 27 controls (age 30 ± 7 year). RV and LV filling were recorded by conventional PW Doppler. Biventricular segmental function was studied using the PW tissue Doppler imaging (TDI) and M-mode techniques.
RESULTS: The 2 patient groups had similar degree of ventricular outflow tract obstruction. Long axis function was impaired while global systolic function was preserved in the pressure-overloaded ventricle. Patients had higher peak late filling (A wave) and TDI late diastolic (Aa) velocities recorded in the disease-free ventricles despite having similar peak early filling velocities (E wave), E wave deceleration time and E/Ea ratios were not different from controls (p > 0.05 for all). Such accentuation of atrial activity (A wave) was moderately correlated with the degree of contralateral ventricular outflow tract obstruction (p < 0.001 for both).
CONCLUSIONS: Long axis function is more sensitive than global function in revealing myocardial dysfunction in the pressure-overloaded ventricles. The increased contralateral atrial systolic activity suggests an evidence for atrial interaction in the form of 'cross talk'.