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  • Left atrial pressure

    Does anyone know how to work out left atrial pressure from an echo? I posted a similar question on the Ask HCMA board and didn't get a single response. Surely someone out there knows how to undertand echos???

    Thanks,

    Paul
    Age 38, dad of two young children, dx 1996, myectomy March 2005, a-fib issues, due for ICD soon.

  • #2
    Paul:
    Sorry but I do not know. Anyhow, I have found out this abstract. I do not have access to the paper. Perhaps it can help?

    Valentine, April Lynn, Pope, Jeff, Read, Terry Evaluation of Left Atrial Size and Pressure as It Relates to Left Ventricle Diastolic Measurements in Patients With Left Ventricle Hypertrophy Journal of Diagnostic Medical Sonography 2003 19: 73-79

    The purpose of this prospective study was to determine whether left atrial size, pressure, and ejection fraction are useful in diagnosing patients with left ventricle (LV) diastolic dysfunction through noninvasive means. Mitral valve and pulmonary vein Doppler measurements are used currently to diagnose LV diastolic dysfunction (LVDD). The left atrium (LA) influences these Doppler measurements. By coordinating Doppler and LA values, an understanding of the LA could help with LVDD patients. Thirty-four patients (15 men, 19 women; mean age 65.6 ± 14 years) were evaluated by echocardiography. M-mode of the left ventricle and mitral flow E/A ratio were used in determining LV diastolic dysfunction. Apical four- and two-chambers were measured to find left atrial volume and area. Left atrial ejection fraction (LAEF) was calculated as the percentage of blood expelled in a cycle. LA pressure evaluated through pulmonary wedge pressure was related to E/A wave velocity ratio (P = 1.11E-07, r = .77). Maximum left atrial volume was significant in patients with mild LVH measurements (P = .03, r = .53) and patients with E/A wave velocity ratio < 1.0 (P = .02, r = .65). While LA pressure and maximum left atrial volumes prove to be useful in evaluating patients with LV diastolic dysfunction throughout this study, LAEF is not significant when correlated with these patients.

    Key Words: left ventricle diastolic dysfunction • left ventricular hypertrophy • left atrial size • left atrial pressure

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    • #3
      I don't know. Maybe one of our nurses or Lisa can answer you.

      Reenie
      Reenie

      ****************
      Husband has HCM.
      3 kids - ages 23, 21, & 19. All presently clear of HCM.

      Comment


      • #4
        Paul,

        The standard procedure for measuring pressures in the heart is angiogram/heart catheterization. There might be some obscure way to deduce pressures from echo but I don't think it would be very reliable. Dimensions from the echo and velocities via doppler pretty-much lead to all the other calculated figures, including gradient, but not absolute pressure.

        Regards,
        Rob Thomas
        --Living life on the edge .. of a continent!
        Charter member: Tinman Club

        Comment


        • #5
          Thanks. I realize that echos provide only a rough estimation of diastolic function, but what are the important numbers? Does the E/A ratio tell us anything?

          Fausto, thanks for the reference. We do not have access to that journal here, so maybe you have a copy?

          Take care,

          Paul
          Age 38, dad of two young children, dx 1996, myectomy March 2005, a-fib issues, due for ICD soon.

          Comment


          • #6
            Paul,

            I think you are asking for measures of "left ventricular diastolic function" and "left atrium function" in this thread and in the previous question (which didn't turn out to be much of a "discussion thread"). I don't believe quantitative measures for these things exist, only qualitative measures ("good, poor, bad"). If quantitative measures did exist I'm sure I would have seen them in the echo and MRI test results at Mayo Clinic. Systolic function is a completely different story, with EF being the most obvious quantitative example.

            In my particular case of "severe diastolic dysfunction" the echo reflects severe regurgitation as a result of the diastolic dysfunction. The real diagnostic info on diastolic function came from a cath / angiogram (pressures, including pulmonary pressure) and from a treadmill exercise test, not the echo.

            I can sympathize with wanting to put a number to the diastolic problem, but I don't think the echo provides what you're looking for--sorry.

            Regards,
            Rob
            --Living life on the edge .. of a continent!
            Charter member: Tinman Club

            Comment


            • #7
              Hi Rob,

              Thanks for the reply. I read somewhere that there are a number of measurements that can be taken with echo, which give an idea of diastolic function. One of these is Isovolumetric Relaxation Time (IVRT). I believe this is calculated from some of the other measurements taken on echo. The problem is that in most of my echos they did not fill in a number for IVRT. There are other measurements which can be applied to work out diastolic function are things like 'DT' (in msec) and PV "A". The problem is I do not know how to get from these measurements to the IVRT.

              I am very curious because diastolic function is a crucial component of HCM. I want to know what my baseline is so I can figure out if there is any improvement following my myectomy: diastolic function (and in turn left atrial pressure) is supposed to improve in many people after myectomy.

              Thanks,

              Paul
              Age 38, dad of two young children, dx 1996, myectomy March 2005, a-fib issues, due for ICD soon.

              Comment


              • #8
                Paul,

                I certainly understand the desire for a baseline...

                IVRT sounds like it could very well be a machine-based calculation that depends on the sonographer to make some calculation specific measurements during the examination--probably need to ask an echo technician about it to be sure. For what it's worth, IVRT isn't reported on my echo results from Mayo, either (there isn't even a space for a value, it's just not mentioned at all).

                All other things being equal, you could look at regurgitant velocity as something of an indicator.

                Way past my bedtime.

                Rob
                --Living life on the edge .. of a continent!
                Charter member: Tinman Club

                Comment


                • #9
                  Rob,

                  Thanks for the info. Is regurgitant velocity related to the mitral regurgitation? If so, I think that is the E value that is commonly written on an echo. If so, do you know what the numbers mean?

                  Thanks again Rob. And get to bed, it got be be late there. We are on a different time zone here, so often there are usually few people on line when I am!

                  Paul
                  Age 38, dad of two young children, dx 1996, myectomy March 2005, a-fib issues, due for ICD soon.

                  Comment


                  • #10
                    This is getting pretty deep into textbook territory--is there a med school/hospital near you? There's a good medical book store in UCLA's hosptial. I noticed a book or two on echocardiograms there.

                    Going back to my echo report:

                    E appears to be velocity (in m/sec) for Mitral Valve Diastolic. There is a normal range provided of 0.4-0.8 in my case.

                    Regurgitant velocities (in m/sec) are provided for both mitral valve systolic and tricuspid valve systolic. No normal ranges provided.

                    DT could be either Deceleration time (Mitral, diastolic) or regurgitant delta time (mitral systolic). There is a calculated value of dP/DT (mitral systolic) in mmHg/sec wihich is derived from Regurg. velocity, regurg. TVI (cm) and regurg. delta time.

                    Have you thought about different measures of diastolic function, like exercise test results as a measure of effectiveness?

                    THAT pretty much exhausts my resources on the subject!

                    good luck,
                    Rob
                    --Living life on the edge .. of a continent!
                    Charter member: Tinman Club

                    Comment

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