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1 Cardiovascular Biphysics Laboratory and Cardiovascular MR Laboratories, Cardiovascular Division, Washington University School of Medicine, St Louis, MO, USA
* To whom correspondence should be addressed. E-mail: sjk{at}wuphys.wustl.edu.
Even though modeling the four-chambered heart as a constant-volume pump successfully predicts causal physiologic relationships between cardiac indexes previously deemed unrelated, the real four-chambered heart slightly deviates from the constant-volume state by ventricular end-systole. This deviation has consequences which impact chamber function, specifically left atrial (LA) function. LA attributes have been characterized as booster pump, reservoir, and conduit functions, yet characterization of their temporal occurrence or their causal relationship to global heart function has been lacking. We investigated LA function in the context of the constant-volume attribute of the left heart in ten normal subjects using cardiac magnetic resonance imaging (MRI) and contemporaneous Doppler echocardiography, synchronized via the electrocardiogram. Left ventricular (LV) and LA volumes as a function of time were determined via MRI. Transmitral flow, pulmonary vein (PV) flow, and lateral mitral annular velocity were recorded via echocardiography. The relationship between the MRI-determined diastolic LA conduit volume filling rate and systolic LA filling rate correlate well with the relationship between the echocardiographically-determined average flow rate during the early portion of the PV D-wave and the average flow rate during the PV S-wave (r = 0.76). We conclude that the end-systolic deviation from constant-volume for the left heart requires the generation of the LA conduit volume during diastole. Because early rapid filling of the LV is the driving force for LA conduit volume generation, while the LA remains passive, it may be more appropriate to consider LA conduit volume a property of ventricular diastolic function rather than atrial function.
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