Balaji Pandian, P (2013) Assessment of Left Atrial Functional Index (LAFI) by Transthoracic Echocardiogram in patients with Atrial Fibrillation and Diastolic dysfunction. Masters thesis, Madras Medical College, Chennai.
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Abstract
In the past, left atrium was thought of as a chamber that passively transports blood from the pulmonary circulation to the left ventricle. But it is not so. During the later half of the last century, multiple studies were conducted to obtain normal values for left atrium. S o far several echocardiographic variables have been developed for the evaluation of the function of left atrium. The size of the left atrium in M mode, trans mitral flow velocities, (E & A ) tissue Doppler estimation of myocardial relaxation ( e’ & a’) are the ones useful in the evaluation of the left atrial function. Another important parameter, Left atrial funtional index1,3 (LAFI) is a ratio that involves the analogues of left ventricular stroke volume, reservoir function of left atrium and the size of the left atrium. LAFI adjusts for extremes of body weight and extremes of heart rate. In otherwords it is rhythm independent3 . In patients with AF and normal sized left atrium ( good emptying during diastole) the LAFI should be normal. AIMS AND OBJECTIVES: To evaluate Left Atrial Functional Index (LAFI) using Transthoracic Echocardiogram in persons suffering from atrial fibrillation and also in patients with diastolic dysfunction and the comparison of this left atrial functional index to the conventional echocardiogrophic parameters of left atrial function. CONCLUSION: For the evaluation of left atrium no single parameter is sufficient. Several traditional parameters like LAOT A wave peak velocity, LAOT A VTI and fraction of atrial contribution to ventricular filling, are dependent on the rhythm as well as the Systolic function of the LV. L e ft atrial volume indexed to body surface area was higher in persons with abnormal transmitral filling patterns as well as in patients with chronic atrial fibrillation. Left atrial volume is increased in patients with left atrial dysfunction. Several studies have confirmed that measurement of left atrial volume is an independent predictor of cardiovascular events in patients with HFpEF. Our study demonstrates clear association between left atrial volume and left atrial dysfunction. W e found that the Left Atrial Functional Index as measured by echocardiogram, is decreased in patients with abnormal myocardial relaxation and also in persons with chronic atrial fibrillation. Since this parameter incorporates cardiac output and body surface area in addition to left atrial end systolic volume, it is rhythm independent marker for left atrial function. T he predictors of the left atrial functional index are the baseline left atrial dimension by M mode Echo and the rhythm at the time of evaluation. These factors remain independent predictors of LAFI even after correction for other parameters. Thus baseline LA dimension has got negative association with LAFI and sinus rhythm has got positive association with LAFI. LAFI can be used in the prognostication of heart failure with normal ejection fraction group of patients. The prognostic value of LAFI can be increased, when it is used in association with Other clinical risk factors and NT-proBNP. Because LAFI is a rhythm independent marker of left atrial function, it can be used as a marker of left atrial dysfunction in patients with atrial fibrillation. In the future, the LAFI may be used as a potential target for therapeutic maneuvers.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Left Atrial Functional Index (LAFI) ; Transthoracic Echocardiogram ; patients ; Atrial Fibrillation ; Diastolic dysfunction. |
| Subjects: | MEDICAL > Cardiology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 04 Jul 2017 07:42 |
| Last Modified: | 04 Jul 2017 07:42 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/889 |
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