Left Atrial Ejection Force (LAEF) in Patients With Hypertension: LAEF Is Decreased in Hypertensive Patients With Left Ventricular Failure Or Atrial Fibrillation

Journal of Clinical and Basic Cardiology 2002; 5 (3): 237-240

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Keywords: dekompensierte Herzinsuffizienz,  Hypertonie,  Kardiologie,  linksartiale Kontraktion,  linksartriale Auswurfkraft,  Vorhofflimmern,  atrial fibrillation,  congestive heart failure,  hypertension,  left atrial contraction,  left atrial ejection force

Background: Left atrial (LA) contraction is an important parameter in hypertensive (HT) patients. However, it is difficult to evaluate LA contraction non-invasively. Recently, a Doppler echocardiogram derived left atrial ejection force (LAEF) method was introduced for evaluating LA contraction. We studied LAEF in patients with HT. Subjects: One hundred and twenty-four patients with HT were studied. There were 74 men and 50 women. Age ranged 35-77 years. Thirty-five normal subjects and 20 patients with congestive heart failure (CHF) or paroxysmal atrial fibrillation (PAF) were also studied. Principle: According to Newton’s law of motion, LAEF is calculated as LA ejection volume x acceleration of flow. LA ejection volume = mitral valve area (MVA) x time velocity integral of mitral flow. Acceleration is the slope of atrial flow velocity. Methods: (1) MVA was calculated by 2-D echo. Mitral flow velocity was recorded by pulsed Doppler. (2) LAEF was calculated as 1/3 x MVA x A2, where A is the atrial flow velocity. (3) LAEF was compared with WHO stage and period of HT. (4) LAEF was compared between patients with and without CHF or PAF. Results: (1) In normal subjects, LAEF correlated with age (r = 0.74, p < 0.001). Therefore, age corrected %LAEF was used for analysis. %LAEF = (actual LAEF) / (normal LAEF) x 100. (2) In patients with HT, %LAEF was 107.8 ± 5.7 % in WHO stage I, 111.6 ± 8.0 % in stage II and 105.7 ± 13.5 % in stage III (n.s.). %LAEF was higher in patients with WHO stage I and II than normal subjects. (3) %LAEF was 111.6 ± 6.0 % in patients with period < 9 years, 108.6 ± 9.0 % in period 10–20 years and 105.8 ± 11.2 % in period > 20 years. %LAEF had a tendency to decrease with period of HT (n.s.). (4) %LAEF was 50.5 ± 22.4 % in patients with PAF, and was 64.3 ± 31.8 % in patients with CHF. %LAEF was lower in hypertensive patients with CHF or PAF than without CHF or PAF (p < 0.001). Conclusions: LAEF may be compensated in mid stage of hypertension and decompensated in late stage of hypertension. LAEF is decreased in hypertensive patients with paroxysmal atrial fibrillation or congestive heart failure.