Pulmonary venous flow reversal and its relationship to atrial mechanical function in normal subjects - Umeå General Population Heart Study

Aims: Although pulmonary venous flow reversal (Ar) is useful in the evaluation of left ventricular (LV) diastolic function, it is often difficult to study with transthoracic echocardiography (TTE). We determined the relationship between Ar and left atrial (LA) mechanical function and sought to define surrogate measurements for Ar. Methods and results: A total of 130 healthy subjects, mean age 54.3 ± 18.3 years, 62 women, were studied and classified into three groups: [young (Y), 25-44 years; n = 44], [middle-age (M), 45-64 years; n = 43] and [elderly (E), ≥65 years; n = 43]. Pulmonary venous flow and LV inflow studies were performed by TTE and LV basal free-wall motion was studied by Doppler tissue imaging (DTI). All images were acquired with a superimposed electrocardiogram. RR interval was similar in all groups while LA dimension and PR interval were increased in Group E vs. Y (P < 0.001). LA contraction (A_m) on DTI, transmitral A-wave (A) and Ar were simultaneous and started 84 ms after onset of P wave and this interval increased with age (P = 0.02). Similarly, the time intervals from the same landmark to peak A_m, A, and Ar were prolonged with age (all, P < 0.001). Despite this prolongation, peak A_m coincided with peak Ar in every age group (r = 0.97, P < 0.001) and Ar acceleration and deceleration times were consistently equal. Conclusion: The timing of A_m obtained by DTI can be used to accurately estimate corresponding measurements of Ar recorded by TTE in subjects without cardiac disease.