|| Checking for direct PDF access through Ovid
Acute hypertensive pulmonary edema (AHPE) is associated with longitudinal left ventricular (LV) dysfunction (data reported previously). We hereby report the acute changes in left atrial (LA) function during AHPE.Methods: 24 patients (71±10 yrs, 18 women) with acute dyspnoea within the preceding 8h, pulmonary congestion, sinus rhythm, systolic BP≥160mmHg, and adequate LA images were assessed at admission, and after 48-92h; significant valvular disease and acute myocardial infarction were excluded. LA function was evaluated by conventional and speckle-tracking echo from the apical 4C and 2C views. LA volumes at MVC, MVO, and at the onset of P-wave, and also mean global LA strain, strain rate, and derived times were measured. Active LA function was assessed by active EF (EFa=prePvol-MVCvol)/prePvol), mean negative global strain at maximal atrial contraction (MSA-), and time from P onset to peak (MTSA-); passive function from passive EF (EFp=MVOvol-prePvol)/MVOvol), mean positive peak global strain (MSA+), and time from R-wave to peak (MTSA+), and also from mean early negative global strain rate in early LV diastole (MSRE); reservoir function from the sum of MSA- and MSA+ (MSASUM), mean positive global strain rate at the beginning of LV systole (MSR+), time from P to peak (MTSR+), and expansion index (EFr=MVOvol–MVCvol)/MVCvol). LV systolic function was assessed by EF, mean longitudinal strain and strain rate; diastolic function by E/Ea and E/Vp ratios.Results: There were no changes in global systolic and diastolic LV function. Active LA function was not changed during AHPE, however LA relaxation (MSA+) was significantly lower, and reservoir function was shorter (MTSR+) during AHPE. MSA- correlated significantly (r=0.4-0.6) with LV longitudinal dysfunction (strain and strain rate). LA relaxation (MSA+) correlated with EF, LVstrain, and LV end-diastolic pressure (E/Vp).Conclusion: LA relaxation function is lower during AHPE, which correlates with longitudinal LV dysfunction. LA active function was not changed, probably because of similar preload stretch and atrial afterload (E/Ea, E/Vp).