Assessment of Inter and Intra-atrial Asynchrony in Patients with Systolic Heart Failure Using Velocity Vector Imaging

BACKGROUND: According to previous studies on the deformation properties of the left atrium, the systolic strain and strain rates represent the atrial reservoir function and the early and late diastolic strain rates show the conduit and booster functions, respectively. OBJECTIVES: We sought to evaluate the intra and interatrial asynchrony using strain/strain rate imaging in systolic heart failure patients. PATIENTS AND METHODS: Twenty five patients with systolic heart failure (LVEF ≤ 40%) were enrolled into the study. Asynchrony quantifications were performed according to the standard deviation of time-to peak (TP-SD) of deformation of three segments manually located along the perimeter of the left atrium free wall, right atrium free wall and interatrial septum, as imaged in an apical four-chamber view. We also calculated classic echocardiography parameters such as LV end-diastolic dimension index, LA volume index, RA area, as well as deceleration time (DT) on transmitral pulsed wave Doppler and E/E’ ratio on mitral annular tissue Doppler imaging. RESULTS: In heart failure patients either inter or intra-atrial asynchrony were far more common in comparison with normal subjects (P=0.008 and P=0.007 respectively). CONCLUSIONS: Left ventricular systolic heart failure, may result in inter and intra-atrial asynchrony even in clinically stable patients without significant pulmonary hypertension and diastolic dysfunction.