EVALUATION OF LEFT ATRIAL ACTIVE CONTRACTION AND RELAXATION IN VARIOUS MYOCARDIAL DISEASES BY TRANSESOPHAGEAL PULSED DOPPLER-ECHOCARDIOGRAPHY OF LEFT-VENTRICULAR INFLOW AND PULMONARY VENOUS FLOW

The purpose of this study was to evaluate the left atrial active contraction and relaxation in patients with various myocardial diseases by analyzing pulmonary venous flow (PVF) and left ventricular inflow (LVIF) velocity patterns, using transesophageal pulsed Doppler echocardiography. We studied 60 patients with sinus rhythm (25 with hypertrophic cardiomyopathy, 15 with dilated cardiomyopathy and 20 with old myocardial infarction) and 15 normal controls. The peak first systolic PVF velocity (PVS1) in patients with dilated cardiomyopathy were smaller than those of normal controls and patients with hypertrophic cardiomyopathy and old myocardial infarction. The peak atrial systolic LVIF (LVIF-A) and PVF (PVA) velocities and left atrial volume change during atrial contraction in hypertrophic cardiomyopathy and old myocardial infarction were larger than those of normal controls and patients with dilated cardiomyopathy. The relation between the PVS1 and the PVA shifted toward the left and inferiorly in patients with dilated cardiomyopathy, and toward the left and superiorly in patients with hypertrophic cardiomyopathy and old myocardial infarction as compared with normal controls. PVA and left ventricular end-diastolic pressure (LVEDP) determined by cardiac catheterization showed no overall correlation in the 23 patients examined, but a good positive correlation in the 15 patients with hypertrophic cardiomyopathy and old myocardial infarction, excluding the 8 with dilated cardiomyopathy. The ratio (PV-A/S-1) of the PVA to the PVS1 correlated positively with the LVEDP in all the 23 patients. Thus, the PVS1 of PVF velocity reflects left atrial relaxation, and both the atrial systolic waves of PVA and LVIF-A velocities reflect booster pump function of the left atrium in addition to left ventricular compliance at end-diastole. Conjunctional use of PVF and LVIF velocities can help in evaluating left atrial active contraction and relaxation in various myocardial diseases.