Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2022; 19 (4): 287-392 ➤ Анатомия и функция левого предсердия: от диагностики к клинической практике

Anatomy and function of the left atrium: from diagnostics to clinical practice

Authors: Koksheneva I.V., Kaplenko L.I.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2022-19-4-302-313

UDC: 616.125.2-091

Link: Clinical Physiology of Blood Circulaiton. 2022; 4 (19): 302-313

Quote as: Koksheneva I.V., Kaplenko L.I. Anatomy and function of the left atrium: from diagnostics to clinical practice. Clinical Physiology of Circulation. 2022; 19 (4): 302–13 (in Russ.). DOI: 10.24022/1814-6910-2022-19-4-302-313

Keywords:  left atrial anatomy normal left atrial physiology left atrial remodeling atrial myopathy assessment of left atrial myocardial deformity left atrial mechanical function

Received / Accepted:  24.10.2022 / 16.12.2022

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Abstract

Today, there is a reassessment of the role of the left atrium (LA) in the pathogenesis of symptoms and the impact on the prognosis of cardiovascular diseases. There is extensive evidence that structural and functional abnormalities of the LA myocardium, which are present in many cardiovascular diseases, are a powerful prognostic indicator. According to modern concepts, the left atrium in the physiology of systemic hemodynamics has gradually moved from a passive chamber to a central and active element of general hemodynamics. The anatomical, mechanical, hemodynamic, electrophysiological and rheological role of LА has been proven.
The article presents an overview of research on the anatomy, physiology, features of remodeling and dysfunction of the left atrium, presents modern diagnostic approaches to assessing the geometry and function of the left atrium. The information content and predictive accuracy of the assessment of the geometry and mechanical function of the LA in predicting negative cardiovascular outcomes are considered.
In the future, studies on the problem of left atrial dysfunction will improve diagnosis, create the basis for a deeper understanding of the mechanisms underlying LA dysfunction and the development of effective treatment methods.

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****
  1. Triposkiadis F., Pieske B., Butler J., Parissis J., Giamouzis G., Skoularigis J. et al. Global left atrial failure in heart failure. Еur. J. Heart Fail. 2016; 18: 1307–20. DOI: 10.1002/ejhf.645
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  4. Álvarez-García J., Vives-Borrás M., Gomis P., OrdoñezLlanos J., Ferrero-Gregori A., Serra-Peñaranda A., Cinca J. Electrophysiological effects of selective atrial coronary artery occlusion in humans. Circulation. 2016; 133: 2235–42. DOI: 10.1161/CIRCULATIONAHA.116.021700.
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  6. Boudoulas K.D., Paraskevaidis I.A., Boudoulas H., Triposkiadis F.K. The left atrium: from the research laboratory to the clinic. Cardiology. 2014; 129 (1): 1–17. DOI: 10.1159/000360935
  7. Sirbu C., Herbots L., D'hooge J., Claus P., Marciniak A., Langeland T. et al. Feasibility of strain and strain rate imaging for the assessment of regional left atrial deformation: a study in normal subjects. Eur. J. Echocardiogr. 2006; 7 (3): 199–208. DOI: 10.1016/j.euje.2005.06.001
  8. Shen M.J., Arora R., Jalife J. Atrial Myopathy. JACC: Basic. Transl. Sci. 2019; 5 (4): 640–54. DOI: 10.1016/j.jacbts.2019.05.005
  9. Singh A., Carvalho Singulane C., Miyoshi T., Prado A.D., Addetia K., Bellino M. et al. WASE Investigators. Normal values of left atrial size and function and the impact of age: results of the World Alliance Societies of Echocardiography Study. J. Am. Soc. Echocardiogr. 2022; 35 (2): 154–64.e3. DOI: 10.1016/j.echo.2021.08.008
  10. Badano L.P., Kolias T.J., Muraru D., Abraham T.P., Aurigemma G., Edvardsen T. et al. Industry representatives; Reviewers: This document was reviewed by members of the 2016-2018 EACVI Scientific Documents Committee. Standardization of left atrial, right ventricular, and right atrial deformation imaging using twodimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur. Heart. J. Cardiovasc. Imaging. 2018; 19 (6): 591–600. DOI: 10.1093/ehjci/jey042
  11. Wright S.P., Dawkins T.G., Eves N.D., Shave R., Tedford R.J., Mak S. Hemodynamic function of the right ventricular-pulmonary vascular-left atrial unit: normal responses to exercise in healthy adults. Am. J. Physiol. Heart. Circ. Physiol. 2021; 320 (3): H923–41. DOI: 10.1152/ajpheart.00720.2020
  12. Quiñones M.A., Greenberg B.H., Kopelen H.A., Koilpillai C., Limacher M.C., Shindler D.M. et al. Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy. Studies of left ventricular dysfunction. J. Am. Coll. Cardiol. 2000; 35 (5): 1237–44. DOI: 10.1016/s0735-1097(00)00511-8
  13. Rossi A., Temporelli P.L., Quintana M., Dini F.L., Ghio S., Hillis G.S. et al. MeRGE Heart Failure Collaborators. Independent relationship of left atrial size and mortality in patients with heart failure: an individual patient meta-analysis of longitudinal data (MeRGE Heart Failure). Eur. J. Heart. Fail. 2009; 11 (10): 929–36. DOI: 10.1093/eurjhf/hfp112
  14. Rossi A., Cicoira M., Zanolla L., Sandrini R., Golia G., Zardini P., Enriquez-Sarano M.J. Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy. Am. Coll. Cardiol. 2002; 40 (8): 1425. DOI: 10.1016/s0735-1097(02)02305-7
  15. Modin D., Sengeløv M., Jørgensen P.G., Olsen F.J., Bruun N.E., Fritz-Hansen T. et al. Prognostic value of left atrial functional measures in heart failure with reduced ejection fraction. J. Card. Fail. 2019; 25 (2): 87–96. DOI: 10.1016/j.cardfail.2018.11.016.23
  16. Potter E.L., Ramkumar S., Kawakami H., Yang H., Wright L., Negishi T. et al. Association of asymptomatic diastolic dysfunction assessed by left atrial strain with incident heart failure. JACC Cardiovasc. Imaging. 2020; 13 (11): 2316–26. DOI: 10.1016/j.jcmg.2020.04.028
  17. Putko B.N., Savu A., Kaul P., Ezekowitz J., Dyck J.R., Anderson T.J. et al. Left atrial remodelling, mid-regional pro-atrial natriuretic peptide, and prognosis across a range of ejection fractions in heart failure. Eur. Heart J. Cardiovasc Imaging. 2021; 22 (2): 220–8. DOI: 10.1093/ehjci/jeaa041
  18. Bytycçi I., Dini F.L., Bajraktari A., Pugliese N.R., D'Agostino A., Bajraktari G. et al. Speckle tracking derived left atrial stiffness predicts clinical outcome in heart failure patients with reduced to mid-range ejection fraction. J. Clin. Med. 2020; 9 (5): 1244. DOI: 10.3390/jcm9051244
  19. Cameli M., Sciaccaluga C., Loiacono F., Simova I., Miglioranza M.H., Nistor D. et al. The analysis of left atrial function predicts the severity of functional impairment in chronic heart failure: The FLASH multicenter study. Int. J. Cardiol. 2019; 286: 87–91. DOI: 10.1016/j.ijcard.2019.03.063
  20. Welles C.C., Ku I.A., Kwan D.M., Whooley M.A., Schiller N.B., Turakhia M.P. Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the Heart and Soul Study. J. Am. Coll. Cardiol. 2012; 59 (7): 673–80. DOI: 10.1016/j.jacc.2011.11.012
  21. Santos A.B., Roca G.Q., Claggett B., Sweitzer N.K., Shah S.J., Anand I.S. et al. Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ. Heart Fail. 2016; 9 (4): e002763. DOI: 10.1161/CIRCHEARTFAILURE.115.002763
  22. Freed B.H., Daruwalla V., Cheng J.Y., Aguilar F.G., Beussink L., Choi A. et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ. Cardiovasc. Imaging. 2016; 9 (3): e003754 DOI: 10.1161/CIRCIMAGING.115.003754
  23. Abbasi S.A., Shah R.V., McNulty S.E., Hernandez A.F., Semigran M.J., Lewis G.D. et al. Left atrial structure and function in heart failure with preserved ejection fraction: a RELAX Substudy. PLoS One. 2016; 11 (11): e0164914. DOI: 10.1371/journal.pone.0164914
  24. Reddy Y.N.V., Borlaug B.A. Left atrial myopathy in heart failure with preserved ejection fraction. Eur. J. Heart Fail. 2020; 22 (3): 486–8. DOI: 10.1002/ejhf.1688
  25. Greenberg J.W., Lancaster T.S., Schuessler R.B., Melby S.J. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur. J. Cardiothorac. Surg. 2017; 52 (4): 665–72. DOI: 10.1093/ejcts/ezx039
  26. Melduni R.M., Suri R.M., Seward J.B., Bailey K.R., Ammash N.M., Oh J.K. et al. Diastolic dysfunction in patients undergoing cardiac surgery: a pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation. J. Am. Coll. Cardiol. 2011; 58 (9): 953–61. DOI: 10.1016/j.jacc.2011.05.021
  27. Tayyareci Y., Yildirimtürk O., Aytekin V., Memic K., Behramoglu F., Demiroglu I.C., Aytekin S. Preoperative left atrial mechanical dysfunction predicts postoperative atrial fibrillation after coronary artery bypass graft operation – a velocity vector imaging-based study. Circ. J. 2010; 74 (10): 2109–17. DOI: 10.1253/circj.cj-10-0197
  28. Her A.Y., Kim J.Y., Kim Y.H., Choi E.Y., Min P.K., Yoon Y.W. et al. Left atrial strain assessed by speckle tracking imaging is related to new-onset atrial fibrillation after coronary artery bypass grafting. Can. J. Cardiol. 2013; 29 (3): 377–83. DOI: 10.1016/j.cjca.2012.06.006
  29. Verdejo H.E., Becerra E., Zalaquet R., Del Campo A., Garcia L., Troncoso R. et al. Atrial function assessed by speckle tracking echocardiography is a good predictor of postoperative atrial fibrillation in elderly patients. Echocardiography. 2016; 33 (2): 242–8. DOI: 10.1111/echo.13059
  30. Ba¸saran Ö., Tigen K., Gözübüyük G., Dündar C., Güler A., Ta¸sar O. et al. Predictive role of left atrial and ventricular mechanical function in postoperative atrial fibrillation: a two-dimensional speckle-tracking echocardiography study. Turk. Kardiyol. Dern. Ars. 2016; 44 (1): 45–52. DOI: 10.5543/tkda.2015.11354
  31. Cameli M., Lisi M., Reccia R., Bennati E., Malandrino A., Solari M. et al. Pre-operative left atrial strain predicts post-operative atrial fibrillation in patients under going aortic valve replacement for aortic stenosis. Int. J. Cardiovasc. Imaging. 2014; 30 (2): 279–86. DOI: 10.1007/s10554-013-0323-6
  32. Pernigo M., Benfari G., Geremia G., Noni M., Borio G., Mazzali G. et al. Atrial function as an independent predictor of postoperative atrial fibrillation in patients undergoing aortic valve surgery for severe aortic stenosis. J. Am. Soc. Echocardiogr. 2017; 30 (10): 956–65.e1. DOI: 10.1016/j.echo.2017.07.001
  33. Sabry A.M., Mansour H.A.E., Abo El-Azm T.H., Mostafa S.A., Zahid B.S. Echocardiographic predictors of atrial fibrillation after mitral valve replacement. Egypt. Heart J. 2017; 69 (4): 281–8. DOI: 10.1016/j.ehj.2017.07.002
  34. Pessoa-Amorim G., Mancio J., Vouga L., Ribeiro J., Gama V., Bettencourt N. et al. Impaired left atrial strain as a predictor of new-onset atrial fibrillation after aortic valve replacement independently of left atrial size. Rev. Española. Cardiol. 2017; 71: 466–76. DOI: 10.1016/j.rec.2017.10.005
  35. Lisi M., Cameli M., Di Tommaso C., Curci V., Reccia R., D'ascenzi F. et al. Mitral regurgitation severity correlates with symptoms and extent of left atrial dysfunction: effect of mitral valve repair. J. Clin. Ultrasound. 2018; 46 (1): 32–40. DOI: 10.1002/jcu.22521
  36. Gabrielli L., Corbalan R., Córdova S., Enríquez A., McNab P., Verdejo H.E. et al. Left atrial dysfunction is a predictor of postcoronary artery bypass atrial fibrillation: association of left atrial strain and strain rate assessed by speckle tracking. Echocardiography. 2011; 28 (10): 1104–8. DOI: 10.1111/j.1540-8175.2011.01518.x
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About Authors

  • Inna V. Koksheneva, Dr. Med. Sci., Senior Researcher; ORCID
  • Lydia I. Kaplenko, Postgraduate; ORCID

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