Atrioventricular phenotypes

Atrioventricular Phenotypes

While the strain only evaluates the deformation of myocardium, the atrioventricular plane displacement and regional contribution to stoke volume can assess the resulting changes of the ventricular structures (Lindholm et al. 2022).

Atrioventricular Plane Displacement (AVPD)

In order to quantify the atrioventricular plane displacement (AVPD), eight points need to be marked: three points in the four-chamber view (RV free wall, LV inferoseptal and anterolateral); three points in the three-chamber view (RV outflow tract, LV anteroseptal and inferolateral) and two points in the two-chamber view (LV anterior and inferior). Afterwards, the LV AVPD can be measured in six points, two from each of the two-, three-, and four-chamber views, while the RV AVPD can be measured in the four-chamber RV-free wall, the RV outflow tract in the three-chamber view and from the mean of the two septal points in the four-chamber and three-chamber view (Ostenfeld et al. 2016).

<figure> <img src="/latex/images/combined/AVPD.png" id="fig:AVPD" alt="Measurement of AVPD in the LV and RV. Panel A demarcate the 2-chamber view. Panel B the 3-chamber view and panel C the 4-chamber view. The upper row shows end-diastole and the lower row end systole. (Lindholm et al. 2022)" /><figcaption aria-hidden="true">Measurement of AVPD in the LV and RV. Panel <strong>A</strong> demarcate the 2-chamber view. Panel <strong>B</strong> the 3-chamber view and panel <strong>C</strong> the 4-chamber view. The upper row shows end-diastole and the lower row end systole. <span>(Lindholm et al. 2022)</span></figcaption> </figure>

  • Definition: Displacement of atrioventricular plane

  • Calculation:

    1. LV: AVPDLV=Δant+Δantlat+Δinflat+Δinf+Δinfsep+Δantsep6\text{AVPD}_{\text{LV}}=\frac{\Delta \text{ant}+\Delta \text{antlat}+\Delta \text{inflat}+\Delta \text{inf}+\Delta \text{infsep}+\Delta \text{antsep}}{6} (Ostenfeld et al. 2016; Lindholm et al. 2022)

    2. RV: AVPDRV=Δantsep+Δinfsep2+ΔRVOT+ΔRVlat3\text{AVPD}_{\text{RV}}=\frac{\frac{\Delta \text{antsep}+\Delta \text{infsep}}{2}+\Delta \text{RVOT}+\Delta \text{RVlat}}{3} (Ostenfeld et al. 2016; Lindholm et al. 2022)

  • Acquisition Type: LAX

  • Reference Range:

    1. LV:

      StudyCohort SizeGenderAgeReference Value (mm)Note
      (Maceira et al. 2006)10male20-2911-25septal
      10male20-2911-27lateral
      10male30-3910-24septal
      10male30-3911-27lateral
      10male40-499-23septal
      10male40-4910-26lateral
      10male50-598-22septal
      10male50-599-25lateral
      10male60-697-21septal
      10male60-698-25lateral
      10male70-796-20septal
      10male70-798-24lateral
      10female20-2910-23septal
      10female20-2913-25lateral
      10female30-399-22septal
      10female30-3912-25lateral
      10female40-499-21septal
      10female40-4911-24lateral
      10female50-598-20septal
      10female50-5911-23lateral
      10female60-697-19septal
      10female60-6910-23lateral
      10female70-796-19septal
      10female70-799-22lateral
      (Seemann et al. 2017)24(14,3)
      (Ostenfeld et al. 2016)33(16.6, 1.9)20 males, 13 females
      (Lindholm et al. 2022)20(16, 2)30% males, 70% females, average age 58 years

    2. RV:

      StudyCohort SizeGenderAgeReference Value (mm)Note
      (Seemann et al. 2017)24(20,4)
      (Ostenfeld et al. 2016)33(21.8, 2)20 males, 13 females
      (Lindholm et al. 2022)20(22, 3)30% males, 70% females, average age 58 years

  • Clinical Associations: Bi-ventricular AVPD is lower in patients with pulmonary arterial hypertension (PAH) (Ostenfeld et al. 2016; Lindholm et al. 2022) and DCM(Carlsson et al. 2007). Mortality in heart failure is strongly related to AVPD as well (Willenheimer et al. 1997).

Note: We need to change the implementation as current implementation is too simple!

Regional Contribution to Ventricular Stoke Volume*

Ventricular stroke volume (SV) is generated from longitudinal shortening and radial contraction. The longitudinal component S**V<sub>lon**g%</sub> is a major contributor to SV and can be quantified from the AVPD and the radial component can be calculated from the septal contribution S**V<sub>sep**t%</sub> and the lateral contribution to SV S**V<sub>lat%</sub>(Lindholm et al. 2022).

  • Definition: Regional Contribution to Ventricular Stoke Volume

  • Calculation: Let the septal volume V<sub>sept</sub> be the volume generated by the septal movement between RV insertion points and the lateral volume V<sub>lat</sub> be the volume between the epicardial dimensions in ED and ES, excluding the volume between the septal RV insertions to the LV, as shown in figure.

    1. Longitudinal contribution: S**V<sub>long%</sub> = AVPD × A/S**V where A is the epicardial area of LV or RV (Ostenfeld et al. 2016)

    2. Septal contribution: S**V<sub>sept%</sub> = V<sub>sept</sub>/S**V (Ostenfeld et al. 2016)

    3. Lateral contribution: S**V<sub>lat%</sub> = V<sub>lat</sub>/S**V (Ostenfeld et al. 2016)

  • Acquisition Type: SAX, LAX

  • Reference Range:

    1. LV Longitudinal contribution:

      StudyCohort SizeGenderAgeReference Value (%)Note
      (Ostenfeld et al. 2016)33(59, 9)20 males, 13 females
      (Lindholm et al. 2022)20(57, 8)30% males, 70% females, average age 58 years

    2. LV Septal contribution:

      StudyCohort SizeGenderAgeReference Value (%)Note
      (Ostenfeld et al. 2016)33(8, 4)20 males, 13 females
      (Lindholm et al. 2022)20(9, 4)30% males, 70% females, average age 58 years

    3. LV Lateral contribution:

      StudyCohort SizeReference Value (%)Note
      (Ostenfeld et al. 2016)33(37, 7)20 males, 13 females
      (Lindholm et al. 2022)20(29, 9)30% males, 70% females, average age 58 years

    4. RV Longitudinal contribution:

      StudyCohort SizeReference Value (%)Note
      (Ostenfeld et al. 2016)33(85, 11)20 males, 13 females
      (Lindholm et al. 2022)20(79, 9)30% males, 70% females, average age 58 years

    5. RV Lateral contribution:

      StudyCohort SizeReference Value (%)Note
      (Ostenfeld et al. 2016)33(27, 9)20 males, 13 females
      (Lindholm et al. 2022)20(31, 6)30% males, 70% females, average age 58 years

  • Clinical Associations: In patients with PAH, the longitudinal and septal contribution to LV stroke volume is lower, while the lateral contribution to LV stroke volume is higher (Ostenfeld et al. 2016; Lindholm et al. 2022).

<figure> <img src="/latex/images/combined/longitudinal.png" id="fig:regional_contrib2" alt="Lateral and septal movement in a healthy control (top) and a patient with pulmonary hypertension (bottom). The movement is demonstrated in short axis in end-diastole (full line) and end-systole (dashed line). The faintly colored area are the septal contribution to stroke volume. The volume derived from the lateral movement is the area between the full and dashed epicardial delineations without the septum.(Ostenfeld et al. 2016)" /><figcaption aria-hidden="true">Lateral and septal movement in a healthy control (top) and a patient with pulmonary hypertension (bottom). The movement is demonstrated in short axis in end-diastole (full line) and end-systole (dashed line). The faintly colored area are the septal contribution to stroke volume. The volume derived from the lateral movement is the area between the full and dashed epicardial delineations without the septum.<span>(Ostenfeld et al. 2016)</span></figcaption> </figure>

<figure> <img src="/latex/images/combined/septal_lateral.png" id="fig:regional_contrib2" alt="Lateral and septal movement in a healthy control (top) and a patient with pulmonary hypertension (bottom). The movement is demonstrated in short axis in end-diastole (full line) and end-systole (dashed line). The faintly colored area are the septal contribution to stroke volume. The volume derived from the lateral movement is the area between the full and dashed epicardial delineations without the septum.(Ostenfeld et al. 2016)" /><figcaption aria-hidden="true">Lateral and septal movement in a healthy control (top) and a patient with pulmonary hypertension (bottom). The movement is demonstrated in short axis in end-diastole (full line) and end-systole (dashed line). The faintly colored area are the septal contribution to stroke volume. The volume derived from the lateral movement is the area between the full and dashed epicardial delineations without the septum.<span>(Ostenfeld et al. 2016)</span></figcaption> </figure>

Atrial Contribution

Atrial contribution can make a significant contribution to left ventricular function in patients convalescing from myocardial infarction, irrespective of the functional derangement that is present (Rahimtoola et al. 1975).

  • Definition: Contribution of atrial contraction to left ventricular filling and stroke volume.

  • Calculation:

    1. Percent atrial contribution to the stroke volume: $%\text{AC}_{\text{LVSV}}=\frac{\text{LVEDV}-\text{LVV}_{\text{pre-A}}}{\text{LVSV}}$ where LVV<sub>pre-A</sub> is the left ventricular volume before atrial contraction (Rahimtoola et al. 1975).

    2. Percent atrial contribution to the end-diastolic volume: $%\text{AC}_{\text{LVEDV}}=\frac{\text{LVEDV}-\text{LVV}_{\text{pre-A}}}{\text{LVEDV}}$(Rahimtoola et al. 1975).

  • Acquisition Type: SAX, LAX

  • Reference Range:

    1. Percent atrial contribution to the stroke volume:

      StudyCohort SizeGenderAgeReference Value (%)Note
      (Rahimtoola et al. 1975)10(21.7, 21.4)
      (Ruijsink et al. 2020)304male45-5410-54
      384male55-6418-50
      241male65-746-50
      297female45-5413-44
      322female55-6417-50
      213female65-7420-51

    2. Percent atrial contribution to the end-diastolic volume:

      StudyCohort SizeGenderAgeReference Value (%)Note
      (Rahimtoola et al. 1975)10(11.9, 9.4)

  • Clinical Associations: For patients with myocardial infarction (MI), the atrial contraction contributed more to left ventricular filling during diastole in terms of contribution to LVEDV and contribution to LVSV (Rahimtoola et al. 1975).

Isovolumetric Pulmonary Vein Transit (IPVT)

  • Definition: The amount of LV filling volume flowing directly from the pulmonary vein into the LV cavity without significant change in LA volume (Aquaro et al. 2019).

  • Calculation: IPVT = LV filling volume − Atrial emptying volume (Aquaro et al. 2019)

  • Acquisition Type: SAX, LAX

  • Reference Range:

    StudyCohort SizeGenderReference Value (mL)Note
    (Aquaro et al. 2019)25(36, 15)

Isovolumetric Pulmonary Vein Transit Ratio (IPVT Ratio)

  • Definition: The ratio between isovolumetric pulmonary vein and atrial emptying volume (Aquaro et al. 2019).

  • Calculation: IPVT Ratio = IPVT/Atrial emptying volume (Aquaro et al. 2019)

  • Acquisition Type: SAX, LAX

  • Reference Range:

    StudyCohort SizeGenderReference ValueNote
    (Aquaro et al. 2019)25(1.2, 0.6)

  • Clinical Associations: The IPVT ratio with a cut-off of 2.4 can distinguish class III diastolic dysfunction (DD) from other groups (Aquaro et al. 2019).

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