Atrial contribution to ventricular filling in mitral stenosis

Jay S. Meisner, Gad Keren, Octavio E. Pajaro, Ariel Mani, Joel A. Strom, Robert W.M. Frater, Shlomo Laniado, Edward L. Yellin

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

Background. The importance of the contribution of atrial systole to ventricular filling in mitral stenosis is controversial. The cause of reduced cardiac output following the onset of atrial fibrillation may be due to an increased heart rate, a loss of booster pump function, or both. Methods and Results. We studied the atrial contribution to filling under a variety of conditions by combining noninvasive studies of patients with computer modeling. Thirty patients in sinus rhythm with mild-to-severe stenosis were studied with two-dimensional and Doppler echocardiography for measurement of mitral flow velocity and mitral valve area (MVA). The mean±SD atrial contribution to left ventricular filling volume was 18±10% and varied inversely with mitral resistance. Patients with mild mitral stenosis (MVA, 1.8±0.7 cm2) and severe mitral stenosis (MVA, 0.9±0.2 cm2) had atrial contributions of 29±4% and 9±5%, respectively. The pathophysiological mechanisms responsible for these trends were further investigated by the computer model. In modeled severe mitral stenosis, increasing heart rate from 75 to 150 beats/min caused an increase of 5.2 mm Hg in mean left atrial pressure, whereas loss of atrial contraction at a heart rate of 150 beats/min caused only a 1.3 mm Hg increase. Conclusions. The atrial booster pump contributes less to ventricular filling in mitral stenosis than in the normal heart, and the loss of atrial pump function is less important than the effect of increasing heart rate as the cause of decompensation during atrial fibrillation.

Original languageEnglish (US)
Pages (from-to)1469-1480
Number of pages12
JournalCirculation
Volume84
Issue number4
DOIs
StatePublished - Oct 1991

Keywords

  • Atrial fibrillation
  • Diastole
  • Echocardiography, Doppler
  • Model, computer

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Atrial contribution to ventricular filling in mitral stenosis'. Together they form a unique fingerprint.

  • Cite this

    Meisner, J. S., Keren, G., Pajaro, O. E., Mani, A., Strom, J. A., Frater, R. W. M., Laniado, S., & Yellin, E. L. (1991). Atrial contribution to ventricular filling in mitral stenosis. Circulation, 84(4), 1469-1480. https://doi.org/10.1161/01.CIR.84.4.1469