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. 1970 Sep;49(9):1605–1618. doi: 10.1172/JCI106378

Left atrial booster function in valvular heart disease

Fred P Heidenreich 1, James A Shaver 1, Mark E Thompson 1, James J Leonard 1
PMCID: PMC322644  PMID: 5449701

Abstract

This study was designed to assess atrial booster pump action in valvular heart disease and to dissect booster pump from reservoir-conduit functions. In five patients with aortic stenosis and six with mitral stenosis, sequential atrioventricular (A-V) pacing was instituted during the course of diagnostic cardiac catheterization. Continuous recording of valvular gradient allowed estimation of flow for each cardiac cycle by transposition of the Gorlin formula. Left ventricular ejection time and left ventricular stroke work in aortic stenosis or left ventricular mean systolic pressure in mitral stenosis were also determined. Control observations were recorded during sequential A-V pacing with well-timed atrial systole. Cardiac cycles were then produced with no atrial contraction but undisturbed atrial reservoir function by intermittently interrupting the atrial pacing stimulus during sequential A-V pacing. This intervention significantly reduced valvular gradient, flow, left ventricular ejection time, and left ventricular mean systolic pressure or stroke work. Cardiac cycles were then produced with atrial booster action eliminated by instituting synchronous A-V pacing. The resultant simultaneous contraction of the atrium and ventricle not only eliminated effective atrial systole but also placed atrial systole during the normal period of atrial reservoir function. This also significantly reduced all the hemodynamic measurements. However, comparison of the magnitude of change from these two different pacing interventions showed no greater impairment of hemodynamic state when both booster pump action and reservoir function were impaired than when booster pump action alone was impaired. The study confirms the potential benefit of well placed atrial booster pump action in valvular heart disease in man.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ABILDSKOV J. A., EICH R. H., HARUMI K., SMULYAN H. OBSERVATIONS ON THE RELATION BETWEEN VENTRICULAR ACTIVATION SEQUENCE AND THE HEMODYNAMIC STATE. Circ Res. 1965 Sep;17:236–247. doi: 10.1161/01.res.17.3.236. [DOI] [PubMed] [Google Scholar]
  2. BROCKMAN S. K. Dynamic function of atrial contraction in regulation of cardiac performance. Am J Physiol. 1963 Apr;204:597–603. doi: 10.1152/ajplegacy.1963.204.4.597. [DOI] [PubMed] [Google Scholar]
  3. Carleton R. A., Graettinger J. S. The hemodynamic role of the atria with and without mitral stenosis. Am J Med. 1967 Apr;42(4):532–538. doi: 10.1016/0002-9343(67)90052-6. [DOI] [PubMed] [Google Scholar]
  4. Carleton R. A., Passovoy M., Graettinger J. S. The importance of the contribution and timing of left atrial systole. Clin Sci. 1966 Feb;30(1):151–159. [PubMed] [Google Scholar]
  5. FINNEY J. O., Jr HEMODYNAMIC ALTERATIONS IN LEFT VENTRICULAR FUNCTION CONSEQUENT TO VENTRICULAR PACING. Am J Physiol. 1965 Feb;208:275–282. doi: 10.1152/ajplegacy.1965.208.2.275. [DOI] [PubMed] [Google Scholar]
  6. GORLIN R., GORLIN S. G. Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. Am Heart J. 1951 Jan;41(1):1–29. doi: 10.1016/0002-8703(51)90002-6. [DOI] [PubMed] [Google Scholar]
  7. GORLIN R., LEWIS B. M., HAYNES F. W., SPIEGL R. J., DEXTER L. Factors regulating pulmonary capillary pressure in mitral stenosis. IV. Am Heart J. 1951 Jun;41(6):834–854. doi: 10.1016/0002-8703(51)90116-0. [DOI] [PubMed] [Google Scholar]
  8. GRANT C., BUNNELL I. L., GREENE D. G. THE RESERVOIR FUNCTION OF THE LEFT ATRIUM DURING VENTRICULAR SYSTOLE. AN ANGIOCARDIOGRAPHIC STUDY OF ATRIAL STROKE VOLUME AND WORK. Am J Med. 1964 Jul;37:36–43. doi: 10.1016/0002-9343(64)90210-4. [DOI] [PubMed] [Google Scholar]
  9. Harley A., Starmer C. F., Greenfield J. C., Jr Pressure-flow studies in man. An evaluation of the duration of the phases of systole. J Clin Invest. 1969 May;48(5):895–905. doi: 10.1172/JCI106048. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Heidenreich F. P., Thompson M. E., Shaver J. A., Leonard J. J. Left atrial transport in mitral stenosis. Circulation. 1969 Oct;40(4):545–554. doi: 10.1161/01.cir.40.4.545. [DOI] [PubMed] [Google Scholar]
  11. Kosowsky B. D., Scherlag B. J., Damato A. N. Re-evaluation of the atrial contribution to ventricular function: study using His bundle pacing. Am J Cardiol. 1968 Apr;21(4):518–524. doi: 10.1016/0002-9149(68)90284-1. [DOI] [PubMed] [Google Scholar]
  12. Kroetz F. W., Leonard J. J., Shaver J. A., Leon D. F., Lancaster J. F., Beamer V. L. The effect of atrial contraction on left ventricular performance in valvular aortic stenosis. Circulation. 1967 May;35(5):852–867. doi: 10.1161/01.cir.35.5.852. [DOI] [PubMed] [Google Scholar]
  13. MITCHELL J. H., GILMORE J. P., SARNOFF S. J. The transport function of the atrium. Factors influencing the relation between mean left atrial pressure and left ventricular end diastolic pressure. Am J Cardiol. 1962 Feb;9:237–247. doi: 10.1016/0002-9149(62)90043-7. [DOI] [PubMed] [Google Scholar]
  14. MITCHELL J. H., GUPTA D. N., PAYNE R. M. INFLUENCE OF ATRIAL SYSTOLE ON EFFECTIVE VENTRICULAR STROKE VOLUME. Circ Res. 1965 Jul;17:11–18. doi: 10.1161/01.res.17.1.11. [DOI] [PubMed] [Google Scholar]
  15. Nolan S. P., Dixon S. H., Jr, Fisher R. D., Morrow A. G. The influence of atrial contraction and mitral valve mechanics on ventricular filing. A study of instantaneous mitral valve flow in vivo. Am Heart J. 1969 Jun;77(6):784–791. doi: 10.1016/0002-8703(69)90412-8. [DOI] [PubMed] [Google Scholar]
  16. SARNOFF S. J., GILMORE J. P., MITCHELL J. H. Influence of atrial contraction and relaxation on closure of mitral valve. Observations on effects of autonomic nerve activity. Circ Res. 1962 Jul;11:26–35. [PubMed] [Google Scholar]
  17. SKINNER N. S., Jr, MITCHELL J. H., WALLACE A. G., SARNOFF S. J. HEMODYNAMIC CONSEQUENCES OF ATRIAL FIBRILLATION AT CONSTANT VENTRICULAR RATES. Am J Med. 1964 Mar;36:342–350. doi: 10.1016/0002-9343(64)90160-3. [DOI] [PubMed] [Google Scholar]
  18. SKINNER N. S., Jr, MITCHELL J. H., WALLACE A. G., SARNOFF S. J. HEMODYNAMIC EFFECTS OF ALTERING THE TIMING OF ATRIAL SYSTOLE. Am J Physiol. 1963 Sep;205:499–503. doi: 10.1152/ajplegacy.1963.205.3.499. [DOI] [PubMed] [Google Scholar]
  19. Samet P., Castillo C., Bernsein W. H. Hemodynamic consequences of sequential atrioventricular pacing. Subjects with normal hearts. Am J Cardiol. 1968 Feb;21(2):207–212. doi: 10.1016/0002-9149(68)90321-4. [DOI] [PubMed] [Google Scholar]
  20. Snell R. E., Luchsinger P. C., Shugoll G. I. The relationship between the timing of atrial systole and the useful work of the left ventricle in man. Am Heart J. 1966 Nov;72(5):653–658. doi: 10.1016/0002-8703(66)90348-6. [DOI] [PubMed] [Google Scholar]

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