University of Sydney, Sydney, NSW, Australia; Department of Cardiology Westmead Hospital; South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
Baker IDI heart and Diabetes Institute and the Alfred Hospital, Melbourne, Victoria, Australia.
J Am Coll Cardiol. 2019 Apr 23;73(15):1961-1977. doi: 10.1016/j.jacc.2019.01.059.
Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume [LAV], and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.
左心房（LA）功能的定义最近已成为一个强大的参数，特别是在评估左心室（LV）舒张功能障碍（LVDD）和射血分数保留型心力衰竭方面。超声心动图评估 LVDD 仍然是一项具有挑战性的任务；最近的建议提供了比以前更简单的方法。然而，所提出的方法的缺点（包括二尖瓣血流、组织速度、最大左心房容积[LAV]和估计的肺动脉收缩压）导致 LVDD 的存在和严重程度在很大一部分患者中仍未确定。最大 LAV 是 LVDD 慢性和严重程度的替代指标，但 LAV 本身是 LVDD 早期阶段的不敏感生物标志物，因为 LA 可能需要时间进行重塑。由于 LA 的主要功能是调节 LV 充盈，因此在 LVDD 的最早阶段出现功能 LA 变化并不奇怪。此外，LA 功能不仅在诊断 LVDD 方面具有附加价值，而且在分级其严重程度和监测治疗效果方面也具有附加价值。本综述对 LA 指标在评估 LVDD 继而射血分数保留型心力衰竭中的作用的现有证据进行了批判性评估。
