CARDIAC IMAGING AND NON-INVASIVE TESTING

Left atrial Frank–Starling law assessed by real-time, three-dimensional echocardiographic left atrial volume changes

Ashraf M Anwar¹, Marcel L Geleijnse², Osama I I Soliman^1,2, Attila Nemes², Folkert J ten Cate²

¹ Cardiology Department, Al-Husein University Hospital, Al-Azhar University, Cairo, Egypt
² Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands

Dr F J Ten Cate, Thoraxcentre, Room Ba 302, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; f.j.tencate{at}erasmusc.nl

Background: The Frank–Starling law describes the relation between left ventricular volume and function. However, only a few studies have described the relation between left atrial volume (LAV) and function.

Objective: To describe an LA Frank–Starling law by studying changes in LAV measured by real-time, three-dimensional echocardiography (RT3DE).

Methods: LAV was calculated by RT3DE in 70 patients at end-systole (LAV_max), end-diastole (LAV_min) and pre-atrial contraction (LAV_pre-A). According to LAV_max, patients were classified into three groups: LAV_max <50 ml (group I), LAV_max 50–70 ml (group II) and LAV_max >70 ml (group III). Calculated indices of LA pump function were active atrial stroke volume (SV), defined as LAV_pre-A – LAV_min, and active atrial emptying fraction (EF), defined as active atrial SV/LAV_pre-A x100%

Results: Active atrial SV was significantly higher in group II than in group I (mean (SD) 19.0 (9.2) vs 8.2 (4.9) ml, p<0.0001), in group III it was non-significantly lower than in group II (16.7 (12.5) vs 19.0 (9.2) ml). Active atrial SV correlated well with LAV_pre-A (r = 0.56, p<0.001), but decreased with larger LAV_pre-A. Active atrial EF tended to be higher in group II than in group I (43.1 (18.2) vs 33.2 (17.5), p<0.10), in group III it was significantly lower than in group II (26.2 (18.5) vs 43.1 (18.2), p<0.01).

Conclusion: A Frank–Starling mechanism in the left atrium could be described by RT3DE, shown by an increase in LA contractility in response to an increase in LA preload up to a point, beyond which LA contractility decreased.

Abbreviations: EF, emptying fraction; LA, left atrial; LAV, left atrial volume; RT3DE, real-time, three-dimensional echocardiography; SV, stroke volume

Keywords: left atrial volume; left atrial function; Starling mechanism; real-time, three-dimensional echocardiography

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