Relations of Left Ventricular Doppler Filling Patterns to Left Atrial Appendage Function and Left Atrial Thrombus Formation in Patients with Left Ventricular Systolic Dysfunction in Sinus Rhythm

In the present study, we investigated the relation of left ventricular (LV) Doppler filling patterns to left atrial appendage (LAA) function, left atrial (LA) spontaneous echo contrast (SEC) and LA thrombus in patients with LV systolic dysfunction with three specific types of LV filling patterns by transesophageal echocardiography (TEE). Forty-four patients with LV systolic dysfunction in sinus rhythm were included in this study. Patients were divided into three groups according to LV filling pattern: Group I: those with an impaired relaxation filling pattern (E wave/A wave <1, n=16), group II; those with a pseudonormal filling pattern (E/A=1-2 , n=12) and group III: those with a restrictive filling pattern (E/A>2, n=16). Eleven subjects without cardiovascular disease were selected as the controls. All patient groups showed significantly lower LV ejection fraction than the control group (p<0.001 for each comparison), and LV ejection fraction was lowest in group III. There was no significant difference in the LAA emptying velocity between the controls and group I (72±4 cm/sec, 61±20 cm/sec, respectively). The LAA emptying velocities were significantly reduced in groups II and III compared with the control group (44±4 cm/sec, 35±14 cm/sec respectively; p<0.01, p<0.001), but there was no significant difference in the LAA emptying velocity between the groups II and III. The maximal LAA areas were significantly larger in group II (5.4±1 cm2) and group III (6.3±1.5 cm2) than in the control group (4±0.7 cm2) (p<0.05, p<0.001, respectively). The maximal LAA areas did not differ between the controls and group I, and between group II and III. With TEE, LA thrombus was present in 2 patients in group I, in 3 patients in group II and 5 patients in group III. There was no significant difference in the occurrence of LA thrombus among the groups. LA SEC by TEE was observed in 5 patients in group I, in 8 patients in group II and in 13 patients in group III. There was significant difference in the occurrence of LA SEC among the groups (p<0.001). In conclusion, LAA dysfunction was noted in patients with LV systolic dysfunction with restrictive and pseudonormal LV filling patterns. Although there was no significant difference in LA thrombus distribution, significant difference was found in LA SEC distribution among three groups according to their LV filling patterns. These results support the idea that marked elevation of LA pressures may reduce LAA function.