To study the association of vascular pedicle width on chest roentgenogram with left atrial emptying fraction, an echocardiographic index of diastolic dysfunction.
32 patients with normal systolic function on echocardiogram were evaluated retrospectively for the measurement of left atrial dimensions. Left atrial end-diastolic (LAD) dimensions were measured at the beginning of QRS complex and end-systolic dimensions (LAS) at the end of T-wave on electrocardiogram on M-mode tracing. Left ventricular end-systolic (LVES) and end-diastolic (LVED) diameter, left ventricular septal and posterior wall thickness were also recorded. Postero-anterior (PA) views of chest X-rays done within four weeks of echocardiogram were studied for the measurement of vascular pedicle width (VPW). Left atrial emptying fraction (LAEF) was calculated as LAD/LAS. LAEF > 75% was considered as an indicator of diastolic dysfunction. Patients were divided into Group I (LAEF 75%). Ratio of E to A velocity (E/A) and deceleration time of E-wave (DT) were also recorded on transmitral Doppler signal.
There were 16 patients in each group. Mean LAEF in Group I was 0.68+0.07 and Group II was 0.83+0.05. There was no significant age difference between the two groups (54.38+17.97 vs. 62.75+14.9;p=0.08). VPW was significantly greater in Group II (VPW62.88+9.07 vs. 48.75+5.48;p<0.0001). Though E/A ratio between two groups was not significant (0.94+0.13 vs. 1.1+0.33) but DT was significantly higher in Group II (223.57+47.83 vs. 177.75+41.66;p<0.01). Septal (1.22+0.27 vs. 1.02+0.31;p<0.03) and posterior wall thickness (0.98+0.23 vs. 1.18+0.21;p<0.01) were significantly higher in Group II.
Vascular pedicle width on PA chest X-ray is significantly increased in patients with LAEF >75%, an index of atrial stretch and diastolic dysfunction, with normal systolic function. Moreover, LAEF>75%, an easy to measure index, can be used to identify patients with diastolic dysfunction.
VPW measured on PA chest X-rays can be a reliable indicator of diastolic dysfunction. Left atrial emptying fraction should be routinely measured on echocardiogram with normal systolic function and if found high should prompt further evaluation.
M. Iqbal, None.