Left atrial myopathy in idiopathic dilated cardiomyopathy

Abstract

To investigate whether left atrial systolic dysfunction in dilated cardiomyopathy is the result of left atrial dilatation, atrial involvement in the myopathic process, or both, 20 patients with aortic stenosis, 14 patients with idiopathic dilated cardiomyopathy, and 10 normal control subjects were studied. Left atrial volumes (cubic centimeters) were echocardiographically measured at mitral valve opening (maximal), mitral valve closure (minimal), and onset of atrial systole (P wave of the electrocardiogram) with the biplane area-length method. Atrial systolic function was assessed by calculating the active emptying fraction, equal to (volume at onset of atrial systole minus minimal volume)/volume at onset of atrial systole. Heart rate was similar in patients with aortic stenosis and dilated cardiomyopathy (83 ± 11 vs 86 ± 15 beats/min, respectively). Maximal volume was similar in patients with aortic stenosis (74.8 ± 26.4 cm³) and dilated cardiomyopathy (79.7 ± 25.3 cm³) but greater (p < 0.0001) than in control subjects (46.4 ± 11.9 cm³). Active emptying fraction was inversely related to volume at onset of atrial systole and to tension at end of atrial systole (aortic stenosis r = −0.61andr = −0.81, respectively; dilated cardiomyopathy r = −0.79 and r = −0.66, respectively). At any given level of volume at onset of atrial systole and tension at end of atrial systole, however, active emptying fraction was lower in patients with dilated cardiomyopathy compared with those with aortic stenosis. Thus left atrial systolic dysfunction in dilated cardiomyopathy is not explained by the degree of left atrial dilatation or left atrial tension at end of atrial systole; this suggests that left atrial myopathy may be involved in the dysfunction.