LEFT ATRIUM FUNCTION

ASSESSMENT BY
ECHOCARDIOGRAPHY

By: Diah Media Rizki, S.Ked

Consultant: dr. Ali Imran, Sp.Rad
 What is an Echo?
Simply it is an ultrasound of the heart using

an echo machine equipped with a range of

probes, each has a spectrum of frequencies

Other names for the same modality are,

transthoracic echo or TTE, cardiac Doppler

cardiac ultrasound or ultrasonography,

What are types of Echocardiography?
 What an Echo can do?
1. Chamber size, thickness and function
2. Assess all cardiac valves
3. Assess hemodynamics
4. Congenital heart diseases
5. Some extracardiac shunts
 More Details
Echocardiography uses high-frequency sound waves (also called ultrasound) that
can provide a moving picture of your heart. The sound waves are sent through the
body with a device called a transducer. The sound waves bounce off of the heart and
return to the transducer as echoes. The echoes are converted into images on a
television monitor to produce pictures of your heart.
 Cont

One-dimensional or M-mode echocardiography is one beam of ultrasound directed toward

the heart. Doctors most often use M-mode echocardiography to see just the left side (or

main pumping chamber) of your heart.

Two-dimensional echocardiography produces a broader moving picture of your heart. Two-

dimensional echocardiography is one of the most important diagnostic tools for doctors.

Doppler echocardiography measures blood flowing through the arteries and shows the

pattern of flow through the heart.

 Main cardiac views

Parasternal

Subcostal

Apical
Parasternal Short Axis

LV, RV, Tricuspid

mitral valve Valve,
LA RA

Aortic
Valve
Pulmonic Valve,
Aorta RVOT
(sometimes)
 Subcostal View
Most practical in trauma setting
Away from airway and neck/chest procedures
Liver as acoustic window
Alternative to apical 4 chamber view
 Parasternal Views

Next best imaging window

Good for imaging LV

Comparing chamber sizes

Localized effusions

Differentiating pericardial from pleural effusions

 Parasternal Long Axis

Near sternum

3rd or 4th left intercostal space

Marker pointed to patients right shoulder

(or left hip if screen is not reversed for
cardiac imaging)
Rotate enough to elongate cardiac
chambers
 Parasternal Short Axis

Obtained by 90 clockwise
rotation of the probe towards
the left shoulder (or right hip)
Sweep the beam from the base
of the heart to the apex for
different cross sectional views
 Apical View
Difficult view to obtain

Allows comparison of ventricular chamber

size
Good window to assess septal/wall motion
abnormalities
Probe marker at 6 oclock (or right shoulder)

4 chamber view

Probe marker at 3 oclock

2 chamber view
 LEFT ATRIUM FUNCTION ASSESSMENT (abstract)

Left atrium enlargement is a pathophysiological response to volume and pressure

overload associated with a wide range of cardiovascular disorders leading to left
ventricle systolic and diastolic dysfunction.
Current imaging techniques such as two and three dimensional echocardiography,
cardiac magnetic resonance imaging and multi-detector computed tomography
allow a detailed assessment of the left atrium.
Abstract cont
The current paper aims to offer an overview of two-dimensional echocardiography
parameters which provide data concerning left atrium dimensions and phasic
functions and may lead to a better understanding of left atrium physiology and
pathology.
Left atrium anatomy and physiology
The LA has a complex morphology, which may render echocardiographic assessment
difficult, due to the oblique position of the interatrial septum and the long and narrow LA
appendage.
The four pulmonary veins enter the LA via the posterior wall and are frequently
inaccessible for venous flow evaluation by Doppler.
The left atrium fulfills three major physiologic roles that influence LV filling and
performance. The left atrium acts as a (1) contractile pump that delivers 15% to 30% of
the entire LV filling, (2) reservoir that collects pulmonary venous return during ventricular
systole, and (3) conduit for the passage of stored blood from the left atrium to the left
ventricle during early ventricular diastole.
Left atrium size assessment

Left atrium diameter

The first parameter to be used for LA assessment was the LA
antero-posterior (AP) diameter measured in the parasternal
long axis view at LV end-systole by using either B-mode (fig
1).
Current guidelines endorsed by the American Society of
Echocardiography recommend the use this parameter to
describe LA enlargement as mild (4146 mm in men or 3942
mm in women), moderate (4751 mm in men or 4346 mm in
women) or severe (52 mm in men or 47 mm in women).
Left atrium size assessment

Left atrium area and volume

Several methods may be used to derive LA volumes such as the cube method, the
area length method, the ellipsoid method or Simpsons modified rule, with the latter
being preferred by most physicians, as it relies on fewer geometrical assumptions
when compared to the previous methods.
An electrocardiogram guided echocardiography allows an accurate quantification of
LA functions by measuring LA volumes at different times during the cardiac cycle.
Measurements are usually taken as follows:
1. at end-systole, just before the opening
of the mitral valve (at the end of the T-
wave on the ECG) the LA maximum
volume (LAVmax) (fig 3).

2. at end-diastole, just before mitral valve

closure (at the beginning of the QRS
complex on the ECG) minimum LA
volume (LAVmin) (fig 4).
3. at mid-diastole, just before atrial
contraction (at the beginning of the P
wave on the ECG) preA volume
(LAVpreA) (fig 5).

Indexed to body surface, the normal

LAVmax is 22+6mL/m2, LAVmin is 11+4
mL/m2, and LAVpreA is 15+5 mL/m2
Left atrium function assessment

Left atrium function assessment using the volumes method

1. LA reservoir function :

LA total emptying volume= LAVmax LAVmin

LA total emptying fraction = (LAVmax LAVmin)/LAVmax

2. LA conduit function :

LA passive emptying volume = LAVmax LAVpreA

LA passive emptying fraction= (LAVmax LAVpreA) /LAVmax

Conduit Volume= stroke volume total emptying volume.

3. LA booster pump function:

LA active emptying volume = LAVpreA LAVmin

LA active emptying fraction = (LAVpreA LAVmin)/LAVpreA

 Left atrium - size

Diameter Area
Normal 2.0-4.0cm Normal <20cm2
Mild 4.0-5.0cm Mild 20-30cm2
Moderate 5.0-6.0cm Moderate 30-40cm2
Severe >6.0cm Severe >40cm2