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Right and left atrial appendage function in patients with mitral stenosis and sinus rhythm

  • Tomás F. Cianciulli
  • María C. Saccheri
  • Jorge A. Lax
  • Alejandra M. Bermann
  • Ricardo J. Méndez
  • Juan E. Guerra
  • Héctor J. Redruello
  • Adriana N. Dorelle
  • Horacio A. Prezioso
  • Luis A. Vidal
Original Paper

Abstract

Tissue Doppler imaging (TDI) is generally used for the assessment of ventricular function, and to a lesser extent, to evaluate the left atrial appendage (LAA). In the present study, we used TDI to analyze the contractile function of the right atrial appendage (RAA). The aim of this study was a comprehensive evaluation of RAA and LAA contractile function in patients with mitral stenosis and sinus rhythm. A total of 69 patients were assessed: group 1 (23 patients with severe MS, 38 ± 11 years, 20 women), group 2 (23 patients with mild MS, 39 ± 12 years, 19 women) and group 3 (23 healthy subjects, 42 ± 14 years, 16 women). Multiplane transesophageal echo was performed in all patients. The RAA was visualized at 130° and the LAA at 0°. TDI sample volume was placed in the tip of both atrial appendages, with an ultrasound beam angle < 10°. Flow velocities and myocardial velocities were measured. The presence of thrombus and/or spontaneous echo contrast (SEC) was assessed. TDI showed in normal subjects, myocardial contraction velocities in RAA similar to that of the LAA (21.8 ± 4.2  vs. 20.1 ± 4 cm/s, respectively, P = NS). In patients with MS, myocardial velocities in both atrial appendages were significantly lower than in normal subjects (RAA: 17.4 ± 5.1 vs. 21.8 ± 4.2 cm/s, respectively, P < 0.01, LAA: 9 ± 5.1 vs. 20.1 ± 4 cm/s, respectively, P < 0.001). Linear regression analysis showed a correlation between the impairment of systolic function of both appendages, pulmonary arterial pressure, valve area and transmitral gradient. Of the 46 patients with MS, patients with intense SEC had lower flow and myocardial velocities in the LAA than patients without SEC (16 ± 5 vs. 50 ± 3 cm/s, 6 ± 2 vs. 10.6 ± 5.6 cm/s, respectively, P < 0.001 and P < 0.001). In healthy subjects, myocardial contraction velocities in both appendages were similar. Patients with MS and sinus rhythm had contractile dysfunction of both appendages, shown by the decrease in myocardial velocities and related to the increase in atrial afterload. Both appendages exhibited a relation between contractile dysfunction and the presence of SEC, but dysfunction was less marked in the RAA, which might explain the lower prevalence of thrombi in the RAA.

Keywords

Right atrial appendage Left atrial appendage Transesophageal echocardiography Doppler tissue imaging Mitral stenosis and sinus rhythm Normal subjects 

Abbreviations

TDI

Pulsed tissue Doppler imaging

LV

Left ventricle

RV

Right ventricle

LAA

Left atrial appendage

RAA

Right atrial appendage

S

Peak systolic flow velocity

Sm

Atrial peak systolic myocardial velocity

SEC

Spontaneous echo contrast

TEE

Transesophageal echocardiography

MS

Mitral stenosis

Notes

Acknowledgments

We thank to Ariel Desseno (General Electric) for your technical assistance.

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Copyright information

© Springer Science+Business Media, B.V. 2009

Authors and Affiliations

  • Tomás F. Cianciulli
    • 1
  • María C. Saccheri
    • 1
  • Jorge A. Lax
    • 1
  • Alejandra M. Bermann
    • 1
  • Ricardo J. Méndez
    • 1
  • Juan E. Guerra
    • 1
  • Héctor J. Redruello
    • 1
  • Adriana N. Dorelle
    • 1
  • Horacio A. Prezioso
    • 1
  • Luis A. Vidal
    • 1
  1. 1.Division of CardiologyHospital of the Government of the City of Buenos Aires “Dr. Cosme Argerich”Buenos AiresArgentina

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