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OUR MISSION: TO REDUCE THE BURDEN OF CARDIOVASCULAR DISEASE
Dr. Paolo Colonna
This Clinical seminar devoted to the Prognostic implications of left atrial size and function obtained its goal: this cardiac chamber, sometimes forgotten or left apart, re-gained its importance in the clinical arena.
The measurement of size and function of the left atrium is very well studied with echocardiography in different settings and diseases -as Dr. Allan Klein from Clevaland Clinic says-: it goes from the old techniques, like M-mode, to the new tissue speckle tracking. The important point is to use the right technique for the right patient: in the general screening, the calculation of the atrial area can be sufficient, while in selected patients it is fundamental to do a complete analysis, from volumes to left atrial appendage function. MRI can also be used and it can obtain more precise information on size and volumes, but –as Dr Mohiaiddin from London wisely specifies- it has to be reserved to particular situations due to its cost and time consumption. When the evaluation of atrial size and function is performed in patients with myocardial infarction, it supplies a significant independent prediction of mortality and morbidity at the multivariate analysis. Dr Hillis from Aberdeen specifies that this prognostic role appears to be independent from age and ejection fraction (two classical factors that enlarge the left atrium), reflects the diastolic ventricular dysfunction and the increase in filling pressures. This pathophysiologic point is similarly observed by Dr Tumminello from Lodi (IT) in patients suffering from heart failure. However, a great clinical factor of the study of left atrial function was underlined by Ariel Cohen from Paris, in patients with chronic and paroxysmal atrial fibrillation. The incidence of cerebral stroke is much higher in patients with atrial dilation or dysfunction (with thrombi, dense echocontrast and low appendage velocities). The new guidelines for anticoagulation leave room for the cardiologist's decision in a large number of patients; in these patients, the left atrium has to be investigated before making this choice.
In conclusion, this reporter's point of view from this session is that a study of the left atrium is too often omitted. It is quick when we have to measure the size with a 2D area (so useful for the prognosis of myocardial infarction), but it is particularly important when we have to characterize atrial function in patients with atrial fibrillation. A modern therapeutic strategy and correct anticoagulation of these patients cannot leave out the function of left atrium studied with echocardiography.
Prognostic implications of left atrial size and function Clinical Seminar