scholarly journals Evaluation of correlation between left atrial pressure and left ventricular end diastolic pressure in patients with mitral regurgiation

2005 ◽  
Vol 52 (S1) ◽  
pp. A61-A61
Author(s):  
Jafar Golshahi ◽  
Amir Raufi
Keyword(s):  
Left Atrial ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Left Atrial Pressure

scholarly journals Direct Measurement of Left Atrial Pressure during Routine Transradial Catheterization

2016 ◽  
Vol 43 (6) ◽  
pp. 503-506
Author(s):  
Faisal Fa'ak ◽  
Bahaeddin Shabaneh ◽  
George Younis
Keyword(s):  
Left Atrial ◽  
Diastolic Pressure ◽  
Direct Methods ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Coronary Catheterization ◽  
Diastolic Left Ventricular Dysfunction ◽  
Ventricular Filling Pressure ◽  
Ventricular Filling

Left atrial pressure indicates the left ventricular filling pressure in patients who have systolic or diastolic left ventricular dysfunction or valvular heart disease. The use of indirect surrogate methods to determine left atrial pressure has been essential in the modern evaluation and treatment of cardiovascular disease because of the difficulty and inherent risks associated with direct methods (typically the transseptal approach). One method that has been widely used to determine left atrial pressure indirectly is Swan-Ganz catheterization, in which a balloon-flotation technique is applied to measure pulmonary capillary wedge pressure; however, this approach has been associated with several limitations and potential risks. Measuring left ventricular end-diastolic pressure has also been widely used as a simple means to estimate filling pressures but remains a surrogate for the gold standard of directly measuring left atrial pressure. We describe a simple, low-risk method to directly measure left atrial pressure that involves the use of standard coronary catheterization techniques during a transradial procedure.

Hemodynamic effects of altering the timing of atrial systole

1963 ◽  
Vol 205 (3) ◽  
pp. 499-503 ◽  
Author(s):  
N. Sheldon Skinner ◽  
Jere H. Mitchell ◽  
Andrew G. Wallace ◽  
Stanley J. Sarnoff
Keyword(s):  
Left Atrial ◽  
Diastolic Pressure ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Hemodynamic Effects ◽  
Ventricular Systole ◽  
Ventricular Filling ◽  
Atrial Systole

The use of heart block dog preparations allowed an investigation at constant ventricular rates of the hemodynamic effects which resulted when the timing of atrial systole was altered relative to ventricular systole. Ganglionic blockade and vagotomy precluded sympathetic reflex compensation in these animals. Lengthening or shortening the interval between left atrial and left ventricular systole (As-Vs interval) produced a decrease in left ventricular end-diastolic pressure (LVEDP), mean aortic pressure, and aortic flow. Mean left atrial pressure (MLAP) increased as did the relation of MLAP to LVEDP. The absence of atrial systole produced similar changes. Lengthening or shortening the As-Vs interval while holding aortic pressure and stroke volume constant resulted in an increase in MLAP and the relation of MLAP to LVEDP. The changes observed in the left atrial pressure tracings suggested and a platinum electrode technique demonstrated that mitral regurgitation can occur with improper timing of atrial systole. The data indicate that properly timed, effective atrial activity can enhance ventricular filling and can preclose the atrioventricular valve.

scholarly journals Understanding preload and preload reserve within the conceptual framework of a limited range of possible left ventricular end-diastolic volumes

2020 ◽  
Vol 44 (3) ◽  
pp. 414-422
Author(s):  
Roger E. Peverill
Keyword(s):  
Left Atrial ◽  
Diastolic Pressure ◽  
Limited Range ◽  
Left Ventricular ◽  
Reciprocal Relationship ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Curvilinear Relationship ◽  
End Diastolic Volume ◽  
Intravenous Fluid Administration

Preload has been variously defined, but if there is to be a direct relationship with activity of the Frank-Starling mechanism in its action to increase the force and extent of contraction, preload must directly reflect myocardial stretch. The Frank-Starling mechanism is activated during any stretch of a cardiac chamber beyond its resting size, which is present immediately before contraction. Every left ventricle has an intrinsic and limited range of possible volumes at end diastole. There is a curvilinear relationship between left ventricular (LV) end-diastolic pressure (LVEDP) and LV end-diastolic volume (LVEDV), and, at maximal or near maximal LVEDV, there will be a high LVEDP. Within the possible range, the LVEDV will be determined by the extent of filling, any change in LVEDV will result in changed activity of the Frank-Starling mechanism, and change in LVEDV might, therefore, be considered to represent change in preload. On the other hand, it is the difference between the current and the maximal possible LVEDV (or the preload reserve) that may be of the most clinical relevance. There is a reciprocal relationship between preload and preload reserve, with minor or absent LV preload reserve indicating that there will be either minimal or no increase in stroke volume following intravenous fluid administration. As left atrial pressure can remain within the normal range when the LVEDP is elevated, it is LVEDP, and not left atrial pressure, that provides the most reliable guide to preload reserve in an individual at a specific period in time.

Restoring forces assessed with left atrial pressure clamps

1996 ◽  
Vol 270 (3) ◽  
pp. H1015-H1020 ◽  
Author(s):  
S. P. Bell ◽  
J. Fabian ◽  
A. Higashiyama ◽  
Z. Chen ◽  
M. D. Tischler ◽  
...  
Keyword(s):  
Steady State ◽  
Left Atrial ◽  
Diastolic Pressure ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Two Dimensional ◽  
Downward Displacement ◽  
Restoring Forces

A negative pressure (P) in the fully relaxed left ventricle (LV) indicates the presence of restoring forces generated during contraction. To assess restoring forces in the intact LV under physiological filling conditions, a servomotor system was used in anesthetized open-chest dogs (n = 8) to produce nonfilling diastoles by left atrial pressure (LAP) clamping during systole such that LAP was less than left ventricular pressure (LVP) during the subsequent diastole. Steady-state LV end-diastolic pressure (EDP) was varied by volume infusion from 4.0 +/- 1.5 (+/-SD) to 12.8 +/- 2.1 mmHg. The corresponding fully relaxed LVPs increased from -2.1 +/- 1.9 to 1.1 +/- 3.2 mmHg, P < 0.001. LAP clamping increased the rate of LVP fall by 34 +/- 28% (P < 0.001) during 10 ms after the LVP dropped below the level of the LVP-LAP crossover of the preceding normal beat. During clamped beats, two-dimensional echo revealed substantial downward displacement of the mitral valve (MV) leaflets despite the reversed LA-LV gradient and absence of filling. Thus 1) restoring forces are present at low physiological EDP but absent at high physiological EDP; 2) filling retards the rate of fall of LVP; 3) even in the absence of filling, the process of LV relaxation facilitates MV opening.

Independent influence of left atrial pressure on regional peak lengthening rates

1990 ◽  
Vol 259 (2) ◽  
pp. H480-H487 ◽  
Author(s):  
B. D. Hoit ◽  
M. LeWinter ◽  
W. Y. Lew
Keyword(s):  
Left Ventricle ◽  
Pressure Gradient ◽  
Left Atrial ◽  
Diastolic Pressure ◽  
Left Ventricular Pressure ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Wide Range

We examined the influence of left atrial pressure on regional peak lengthening rates in six open-chest dogs. Sonomicrometers were implanted in the midwall of the anterior apex, the midanterior wall, and the posterior wall of the left ventricle. A bolus of blood was injected into the left atrium during ventricular systole by a computer-driven power injector to produce an isolated increase in left atrial pressure without altering the peak rate of left ventricular pressure fall, regional systolic shortening, or end-systolic length. Several left atrial injections of different volumes were performed over a wide range of left ventricular end-diastolic pressure (LVEDP) (from 7 to 22 mmHg). The peak lengthening rate increased in direct proportion to the increase of left atrial pressure. This effect was significantly greater in the apical than midanterior or posterior sites and decreased at all sites at higher LVEDP. Similar size left atrial injections produced greater increases in atrioventricular pressure gradient but smaller increases in left atrial pressure at low compared with high LVEDP. We conclude that left atrial pressure is an independent determinant of regional peak lengthening rates in the intact left ventricle. The influence of left atrial pressure is attenuated at higher LVEDP because of a smaller change in the diastolic pressure gradient, although viscoelastic effects may play a role.

scholarly journals Validating Left Ventricular Filling Pressure Measurements in Patients with Congestive Heart Failure: CardioMEMS™ Pulmonary Arterial Diastolic Pressure versus Left Atrial Pressure Measurement by Transthoracic Echocardiography

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Sunit Tolia ◽  
Zubair Khan ◽  
Gunjan Gholkar ◽  
Marcel Zughaib
Keyword(s):  
Heart Failure ◽  
New York ◽  
Left Atrial ◽  
Diastolic Pressure ◽  
Systolic Dysfunction ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Atrial Pressure ◽  
Left Atrial Pressure

Background. Routine ambulatory echocardiographic estimates of left ventricular (LV) filling pressures are not cost-effective and are occasionally fraught with anatomic, physiologic as well as logistical limitations. The use of implantable hemodynamic devices such as CardioMEMS Heart Failure (HF) System has been shown to reduce HF-related readmission rates by remote monitoring of LV filling pressures. Little is known about the correlation between CardioMEMS and echocardiography-derived estimates of central hemodynamics. Methods. We performed a prospective, single-center study enrolling seventeen participants with New York Heart Association functional class II-III HF and preimplanted CardioMEMS sensor. Simultaneous CardioMEMS readings and a limited echocardiogram were performed at individual clinic visits. Estimated left atrial pressure (LAP) by echocardiogram was calculated by the Nagueh formula. Linear regression was used as a measure of agreement. Variability between methods was evaluated by Bland–Altman analysis. Results. Mean age was 74 ± 9 years; 59% (10/17) were males. LV systolic dysfunction was present in 76% (13/17) of subjects. Mean PAdP was 18 ± 4 mmHg and 19 ± 5 mmHg for CardioMEMS and echocardiographic-derived estimates, respectively, with a significant correlation between both methods (r2=0.798,  p≤0.001). Conclusions. Our study illustrates a direct linear correlation between PAdP measured by CardioMEMS and simultaneous measurement of LV filling pressures derived by echocardiography.

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