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CLINICAL STUDIES

Effects of pacing-induced and balloon coronary occlusion ischemia on left atrial function in patients with coronary artery disease

^a Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece

Manuscript received July 31, 1998; revised manuscript received October 9, 1998, accepted November 20, 1998.

Reprint requests and correspondence: Dr. Christodoulos Stefanadis, 9 Tepeleniou Str, 15452 Paleo Psychico, Athens, Greece
cstefan{at}atlas.voa.gr

OBJECTIVES

The aim of this study was to compare left atrial (LA) function in 16 patients with distal left anterior descending (LAD) and in 16 patients with proximal left circumflex (LCx) coronary artery stenosis at rest and immediately after pacing-induced tachycardia (LAD-pacing [P] and LCx-P) or coronary occlusion (LAD-CO and LCx-CO).

BACKGROUND

During left ventricular (LV) ischemia, compensatory augmentation of LA contraction enhances LV filling and performance. The left atrium is supplied predominantly by branches arising from the LCx. Therefore, we hypothesized that one mechanism for the loss of atrial contraction may be ischemic LA dysfunction.

METHODS

Left ventricular and LA pressure–area relations were derived from simultaneous double-tip micromanometer pressure recordings and automatic boundary detection echocardiograms.

RESULTS

Immediately after pacing or after coronary occlusion, LV end-diastolic pressure, LV relaxation, LA mean pressure and LV stiffness significantly increased in all patients. However, the area of the A loop of the LA pressure–area relation, representing the LA pump function, significantly decreased in groups LCx-P and LCx-CO (from 14 ± 3 to 9 ± 2, and from 16 ± 4 to 9 ± 2 mm Hg·cm², respectively, p < 0.05), whereas it increased in groups LAD-P and LAD-CO (from 12 ± 3 to 54 ± 10, and from 16 ± 3 to 49 ± 8 mm Hg·cm², respectively, p < 0.001).

CONCLUSIONS

In patients with LAD stenosis, LV supply or demand ischemia is associated with enhanced LA pump function. However, in patients with proximal LCx stenosis who develop the same type and degree of ischemia, LA branches might have been affected, rendering the LA ischemic and unable to increase its booster pump function.

Abbreviations and Acronyms   A = area   ABD = automatic boundary detection   CO = coronary artery occlusion   +dP/dt, –dP/dt = positive and negative first derivative of pressure   ECG = electrocardiogram   FAC = fractional area change   LA = left atrial   LAD = left anterior descending   LCx = left circumflex   LV = left ventricular   LVAed, LVAes = left ventricular end-diastolic and end-systolic area   P = pacing   ROI = region of interest   Tau = time constant of relaxation

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