-
Journal of Cardiology Jun 2019Diastolic filling of the heart is a complex sequence of multiple inter-related events consisting of processes such as ventricular relaxation, erectile coronary effect,... (Review)
Review
Diastolic filling of the heart is a complex sequence of multiple inter-related events consisting of processes such as ventricular relaxation, erectile coronary effect, visco-elastic forces of the myocardium, ventricular interaction, myocardial stress strain relationships, pericardial restraint, passive filling, and atrial contraction. However, in order to understand diastolic filling from a clinical aspect, a simplified foundation can be used which divides the cardiac cycle into contraction, relaxation, passive filling, and filling at atrial contraction. The mitral flow velocity curves are representative of the relative driving pressure between left atrium and left ventricle and allow one to grade the progression of diastolic dysfunction which occurs in disease states. Doppler tissue imaging is necessary as a surrogate of ventricular relaxation to further determine the stages of diastolic dysfunction in patients with preserved ejection fraction. These Doppler flow velocity curves can be applied to understanding diastolic filling of the heart in patients with both reduced ejection fraction and preserved ejection fraction.
Topics: Cardiomyopathies; Diastole; Echocardiography, Doppler; Female; Heart Atria; Heart Ventricles; Humans; Male; Myocardial Contraction; Ventricular Dysfunction; Ventricular Function
PubMed: 30922613
DOI: 10.1016/j.jjcc.2019.03.002 -
Redox Biology Jun 2023Atrial remodeling is a major contributor to the onset of atrial fibrillation (AF) after myocardial infarction (MI). Tripartite motif-containing protein 21 (TRIM21), an...
Atrial remodeling is a major contributor to the onset of atrial fibrillation (AF) after myocardial infarction (MI). Tripartite motif-containing protein 21 (TRIM21), an E3 ubiquitin protein ligase, is associated with pathological cardiac remodeling and dysfunction. However, the role of TRIM21 in postmyocardial infarction atrial remodeling and subsequent AF remains unclear. This study investigated the role of TRIM21 in post myocardial infarction atrial remodeling using TRIM21 knockout mice and explored the underlying mechanisms by overexpressing TRIM21 in HL-1 atrial myocytes using a lentiviral vector. The expression of TRIM21 in the left atrium of the mouse MI model was significantly elevated. TRIM21 deficiency alleviated MI-induced atrial oxidative damage, Cx43 downregulation, atrial fibrosis and enlargement, and abnormalities in electrocardiogram parameters (prolongation of the P-wave and PR interval). TRIM21 overexpression in atrial myocyte HL-1 cells further enhanced oxidative damage and Cx43 downregulation, whereas these effects were reversed by the reactive oxygen species scavenger N-acetylcysteine. The findings suggest that TRIM21 likely induces Nox2 expression mechanistically by activating the NF-κB pathway, which in turn leads to myocardial oxidative damage, inflammation, and atrial remodeling.
Topics: Mice; Animals; Connexin 43; Atrial Fibrillation; Atrial Remodeling; Myocardial Infarction; Heart Atria; Oxidative Stress; Mice, Knockout; Inflammation
PubMed: 36996623
DOI: 10.1016/j.redox.2023.102679 -
Acta Medica Indonesiana Jan 2022Heart failure is the end of all pathological conditions in the heart. Most accepted paradigms in heart failure are always preceded by left ventricle disfunction.... (Review)
Review
Heart failure is the end of all pathological conditions in the heart. Most accepted paradigms in heart failure are always preceded by left ventricle disfunction. Currently, there are several clinical studies that show that heart failure may occur without prior left ventricular dysfunction. Left atrial dysfunction may play a more important role in heart failure than previously expected. Failure of the left atrium can exist independently of left ventricle dysfunction and mitral valve abnormalities. Atrial failure, just like left ventricular failure, can lead to global heart failure. Etiology, pathomechanism and clinical symptoms of atrial failure are complex and not well understood. This review will explain atrial failure.
Topics: Heart Atria; Heart Failure; Humans; Mitral Valve; Ventricular Dysfunction, Left
PubMed: 35398835
DOI: No ID Found -
Heart Failure Clinics Apr 2019Left atrial size and function parameters are associated with adverse outcomes in multiple disease states, including heart failure with reduced and preserved ejection... (Review)
Review
Left atrial size and function parameters are associated with adverse outcomes in multiple disease states, including heart failure with reduced and preserved ejection fraction. Recent data suggest that phasic left atrial function and left atrial stain measurements also hold prognostic information. Three-dimensional echocardiography provides more accurate and reproducible quantification of left atrial volumes than 2-dimensional echocardiography when compared with cardiac magnetic resonance reference standards. Greater accessibility to these advanced imaging techniques allows for the integration of these parameters into routine clinical practice.
Topics: Atrial Function, Left; Echocardiography; Heart Atria; Heart Failure; Humans
PubMed: 30832811
DOI: 10.1016/j.hfc.2018.12.001 -
JACC. Cardiovascular Imaging Jan 2021
Topics: Atrial Fibrillation; Heart Atria; Heart Failure; Humans; Predictive Value of Tests
PubMed: 33413884
DOI: 10.1016/j.jcmg.2020.09.012 -
European Journal of Heart Failure Nov 2016The left atrium plays an important role in the maintenance of cardiovascular and neurohumoral homeostasis in heart failure. However, with progressive left ventricular... (Review)
Review
The left atrium plays an important role in the maintenance of cardiovascular and neurohumoral homeostasis in heart failure. However, with progressive left ventricular dysfunction, left atrial (LA) dilation and mechanical failure develop, which frequently culminate in atrial fibrillation. Moreover, LA mechanical failure is accompanied by LA endocrine failure [deficient atrial natriuretic peptide (ANP) processing-synthesis/development of ANP resistance) and LA regulatory failure (dominance of sympathetic nervous system excitatory mechanisms, excessive vasopressin release) contributing to neurohumoral overactivity, vasoconstriction, and volume overload (global LA failure). The purpose of the present review is to describe the characteristics and emphasize the clinical significance of global LA failure in patients with heart failure.
Topics: Atrial Fibrillation; Atrial Function, Left; Atrial Natriuretic Factor; Heart Atria; Heart Failure; Humans; Sympathetic Nervous System; Vasoconstriction; Vasopressins; Ventricular Dysfunction, Left
PubMed: 27813305
DOI: 10.1002/ejhf.645 -
Physiological Reports Oct 2021Three-dimensional echocardiography can elucidate the phasic functions of the left atrium if a simultaneous acquisition of a pyramidal full-volume dataset, as gathered... (Review)
Review
Three-dimensional echocardiography can elucidate the phasic functions of the left atrium if a simultaneous acquisition of a pyramidal full-volume dataset, as gathered from the apical window and containing the entire left atrial and left ventricular cardiac sections, is obtained. Hence, conduit can be quantified as the integral of net, diastolic, instantaneous difference between synchronized atrial and ventricular volume curves, beginning at minimum ventricular cavity volume and ending just before atrial contraction. Increased conduit can reflect increased downstream suction, as conduit would track the apex-to-base intracavitary pressure gradient existing, in early diastole, within the single chamber formed by the atrium and the ventricle, when the mitral valve is open. Such a gradient increases in response to adrenergic stimulation or during exercise and mediates an increment in passive flow during early diastole, with the ventricle being filled from the atrial reservoir and, simultaneously, from blood drawn from the pulmonary veins. In this context conduit, and even more conduit flow rate, expressed in ml/sec, can be viewed as an indirect marker of left ventricular relaxation. It is well known, however, that a large amount of conduit (in relative terms) is also supposed to contribute to LV stroke volume in conditions of increased resistance to LV filling, when diastolic function significantly worsens. Stiffening of the atrio-ventricular complex implies increments in LA pressure more pronounced in late systole, causing markedly elevated "v" waves, independently of the presence of mitral insufficiency. The combination of increased atrio-ventricular stiffness and conduit flow is associated with an elevation of the right ventricular pulsatile relative to resistive load that negatively impacts on exercise capacity and survival in these patients. Atrial conduit is an "intriguing" parameter that conveys a noninvasive picture of the complex atrioventricular coupling condition in diastole and its backward effects on the right side of the heart and the pulmonary circulation. Given the easiness associated with its correctly performed quantification in the imaging laboratory, I am sure that conduit will survive the competitive access to the list of valuable parameters capable of deciphering, although not necessarily simplifying, the complex diastolic scenario in health and disease.
Topics: Atrial Function, Left; Diastole; Echocardiography, Three-Dimensional; Heart Atria; Humans; Stroke Volume
PubMed: 34605214
DOI: 10.14814/phy2.15053 -
Journal of the American College of... Dec 2017Atrial fibrillation (AF) and stroke are important major health problems that share common risk factors and frequently coexist. Left atrial (LA) remodeling is an... (Review)
Review
Atrial fibrillation (AF) and stroke are important major health problems that share common risk factors and frequently coexist. Left atrial (LA) remodeling is an important underlying substrate for AF and stroke. LA dilation and dysfunction form a prothrombotic milieu characterized by blood stasis and endothelial dysfunction. In addition, alterations of the atrial cardiomyocytes, increase of noncollagen deposits in the interstitial space and fibrosis, favor the occurrence of re-entry that predisposes to AF. Eventually, AF further impairs LA function and promotes LA remodeling, closing a self-perpetuating vicious circle. Multimodality imaging provides a comprehensive evaluation of several aspects of LA remodeling and offers several parameters to identify patients at risk of AF and stroke. How multimodality imaging can be integrated in clinical management of patients at risk of AF and stroke is the focus of the present review paper.
Topics: Atrial Appendage; Atrial Fibrillation; Atrial Function, Left; Atrial Remodeling; Global Health; Heart Atria; Humans; Incidence; Multimodal Imaging; Stroke
PubMed: 29268928
DOI: 10.1016/j.jacc.2017.10.063 -
Journal of the American Heart... Mar 2018
Topics: Atrial Fibrillation; Atrial Function, Left; Cardiovascular Diseases; Heart Atria; Humans; Risk Factors
PubMed: 29602765
DOI: 10.1161/JAHA.118.008930 -
Kardiologia Polska 2021The speckle-tracking technique has become an easily accessible, quick-to-use, and straightforward tool for assessing advanced myocardial function. Achievements in the... (Review)
Review
The speckle-tracking technique has become an easily accessible, quick-to-use, and straightforward tool for assessing advanced myocardial function. Achievements in the analysis of the left atrium have demonstrated that it plays an important role in the physiology and pathophysiology of the circulatory system. Deformation analysis allows the detection of even subtle functional abnormalities when atrial enlargement is not yet detected. Thus, left atrial strain has a documented diagnostic and prognostic value in many clinical scenarios. Furthermore, this technique is increasingly entering routine clinical practice. The analysis becomes possible thanks to new tools that simplify the speckle-tracking assessment. Left atrial strain improves diagnostic possibilities of standard echocardiographic examination, and its diagnostic and prognostic value is sometimes comparable with more advanced and less available techniques. In this review, we discuss the principles of performing strain analysis and the results of current research, and thus the potential possibilities of sophisticated atrial assessment application in various clinical scenarios.
Topics: Atrial Appendage; Echocardiography; Heart Atria; Humans
PubMed: 34599503
DOI: 10.33963/KP.a2021.0105