This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Barbier, P. Articles by Glantz, S. A. Search for Related Content PubMed PubMed Citation Articles by Barbier, P. Articles by Glantz, S. A. Related Collections Other myocardial biology Animal models of human disease Coronary circulation

(Circulation. 1999;100:427-436.)
© 1999 American Heart Association, Inc.

Basic Science Reports

Left Atrial Relaxation and Left Ventricular Systolic Function Determine Left Atrial Reservoir Function

Paolo Barbier, MD; Steven B. Solomon, PhD; Nelson B. Schiller, MD; Stanton A. Glantz, PhD

From the Cardiovascular Research Institute and Department of Medicine, University of California, San Francisco, and the Istituto di Cardiologia dell'Università di Milano, CNR, Fondazione Monzino, IRCCS, via Parea 4, 20138 Milan, Italy (P.B.).

Correspondence to Stanton A. Glantz, PhD, Cardiology Division, University of California, San Francisco, CA 94143-0124. E-mail glantz{at}medicine.ucsf.edu

Background—Determinants of left atrial (LA) reservoir function and its influence on left ventricular (LV) function have not been quantified.

Methods and Results—In an open-pericardium, paced (70 and 90 bpm) pig model of LV regional ischemia (left anterior descending coronary constriction), with high-fidelity LV, LA, and RV pressure recordings, we obtained the LA area with 2D automated border detection echocardiography, LA pressure-area loops, and Doppler transmitral flow. We calculated LV , LA relaxation (a-x pressure difference divided by time, normalized by a pressure), and stiffness (slope between x and v pressure points of v loop). Determinants of total LA reservoir (maximum-minimum area, cm²) were identified by multiple regression analysis. Different mean rates of LA area increase identified 2 consecutive (early rapid and late slow) reservoir phases. During ischemia, LV long-axis shortening (LAS, LV base systolic descent) and LA reservoir area change decreased (7.3±0.3 [SEM] versus 5.6±0.3 cm², P<0.001) and LA stiffness increased (1.6±0.3 versus 3.1±0.3 mm Hg/cm², P=0.009). Early reservoir area change depended on LA mean ejection rate (LA area at ECG P wave minus minimum area divided by time; multiple regression coefficient=0.9; P<0.001) and relaxation (coefficient=4.9 cm²xms/s; P<0.001). Late reservoir area change depended on LAS (coefficient=8 cm/s; P<0.001). Total reservoir filling depended on LA stiffness (coefficient=-0.31 cm⁴/mm Hg; P=0.001) and cardiac output (coefficient=0.001 cm²xmin/L; P=0.002). The strongest predictor of cardiac output was LA reservoir filling (coefficient=301 L/minxcm²; P<0.001). The v loop area was determined by cardiac output, LV ejection time, , and early transmitral flow.

Conclusions—Two (early and late) reservoir phases are determined by LA contraction and relaxation and LV base descent. Acute LV regional ischemia increases LA stiffness and impairs LA reservoir function by reducing LV base descent.

Key Words: hemodynamics • mechanics • atrium

This article has been cited by other articles:

				A. N. Borg, K. A. Pearce, S. G. Williams, and S. G. Ray Left atrial function and deformation in chronic primary mitral regurgitation Eur J Echocardiogr, October 1, 2009; 10(7): 833 - 840. [Abstract] [Full Text] [PDF]

				T. Ishizu, Y. Seo, S. Kawano, S. Watanabe, T. Ishimitsu, and K. Aonuma Stratification of impaired relaxation filling patterns by passive leg lifting in patients with preserved left ventricular ejection fraction Eur J Heart Fail, November 1, 2008; 10(11): 1094 - 1101. [Abstract] [Full Text] [PDF]

				L. Thomas, M. Hoy, K. Byth, and N. B. Schiller The left atrial function index: a rhythm independent marker of atrial function Eur J Echocardiogr, May 1, 2008; 9(3): 356 - 362. [Abstract] [Full Text] [PDF]

				A. M Anwar, M. L Geleijnse, O. I I Soliman, A. Nemes, and F. J t. Cate Left atrial Frank Starling law assessed by real-time, three-dimensional echocardiographic left atrial volume changes Heart, November 1, 2007; 93(11): 1393 - 1397. [Abstract] [Full Text] [PDF]

				K. Kamohara, Z. B. Popovic, M. Daimon, M. Martin, Y. Ootaki, M. Akiyama, F. Zahr, F. Cingoz, C. Ootaki, M. W. Kopcak Jr, et al. Impact of left atrial appendage exclusion on left atrial function J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 174 - 181. [Abstract] [Full Text] [PDF]

				K. Kamohara, K. Fukamachi, and A. M. Gillinov Reply to the Editor J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 208 - 208. [Full Text] [PDF]

				S. L. Gaynor, H. S. Maniar, J. B. Bloch, P. Steendijk, and M. R. Moon Right Atrial and Ventricular Adaptation to Chronic Right Ventricular Pressure Overload Circulation, August 30, 2005; 112(9_suppl): I-212 - I-218. [Abstract] [Full Text] [PDF]

				S. L. Gaynor, H. S. Maniar, S. M. Prasad, P. Steendijk, and M. R. Moon Reservoir and conduit function of right atrium: impact on right ventricular filling and cardiac output Am J Physiol Heart Circ Physiol, May 1, 2005; 288(5): H2140 - H2145. [Abstract] [Full Text] [PDF]

				F. Kehl, T. T. Kress, B. Mraovic, D. A. Hettrick, J. R. Kersten, D. C. Warltier, and P. S. Pagel Propofol Alters Left Atrial Function Evaluated with Pressure-Volume Relations In Vivo Anesth. Analg., June 1, 2002; 94(6): 1421 - 1426. [Abstract] [Full Text] [PDF]

				S. F. Nagueh, H. Sun, H. A. Kopelen, K. J. Middleton, and D. S. Khoury Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler J. Am. Coll. Cardiol., January 1, 2001; 37(1): 278 - 285. [Abstract] [Full Text] [PDF]

				P. Barbier, S. Solomon, N. B. Schiller, and S. A. Glantz Determinants of forward pulmonary vein flow: An open pericardium pig model J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1947 - 1959. [Abstract] [Full Text] [PDF]