Assessment of left atrial functions in cardiac syndrome X

M. Kuzeytemiz, E. Tenekecioglu, M. Yilmaz, M. Senturk, S. Demir, A. Bekler, B. Aslan

Cardiology Clinic, Bursa Yuksek Ihtisas Research and Education Hospital, Bursa, Turkey. erhantenekecioglu@yahoo.com

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• Cardiology

OBJECTIVE: Cardiac syndrome X (CSX) affects left ventricular functions due to myocardial ischaemia. In this study our aim was to determine the changes in left atrial functions in patients with CSX.

PATIENTS AND METHODS: One-hundred patients (M/F; 57/43) diagnosed with CSX in whom ischaemia was detected at exercise test and myocardial perfusion scintigrapghy with normal coronary angiogram and control group of 80 subjects (M/F; 40/40) were recruited into the study. In transthoracic echocardiography and tissue doppler echocardiography, left ventricular and atrial functions were recorded.

RESULTS: As compared to control group,left ventricular diastolic functions were impaired (E/A; 0.95 ± 0.18 vs 1.11 ± 0.29 p < 0.001), left ventricular end-diastolic pressures were increased (E/Em; 8.1 ± 1.85 vs 6.9 ± 1.74 p < 0.05), and left atrial maximum volume, left atrial pre-A volume,left atrial minimum volume were increased in patients with CSX. Left atrial conduit volume was significantly decreased in patients with cardiac syndrome. Left atrial passive emptying volume (LAPEV), left atrial active emptying volume (LAAEV) and left atrial total emptying volume (LATEV) were significantly increased in patients with cardiac syndrome X. Left atrial passive ejection fration (LAPEF) was found similar between the study groups.Left atrial active ejection fraction (LAAEF) was found significantly increased (37.85 ± 11.89 vs 33.60 ± 9.21; p = 0.009) in patients with CSX. Left atrial total ejection fraction (LATEF) was increased in the group with cardiac syndrome X but it didn’t reach statistical significance (60.85 ± 8.73 vs 58.36 ± 8.29; p = 0.054).

CONCLUSIONS: Left atrial active contractile pump function increase in response to impaired left ventricular diastolic functions in CSX. Increased left atrial pump function represents a compensatory mechanism in patients with CSX. These results point out the importance of maintaining sinus rythm in patients with CSX.

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