The Atrioventricular Coupling in Heart Failure: Pathophysiological and Therapeutic Aspects

Figures

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  Fig. 1.. Atrial and ventricular strain and atrio-ventricular coupling. Left atrial and ventricular strain of systolic and diastolic function. The figure provides a comprehensive overview of atrial and ventricular strain during systolic and diastolic functions. The upper portion illustrates the left atrial strain in normal subjects, segmented into three distinct phases: Reservoir, Conduit, and Contraction. Meanwhile, the lower segment of the figure depicts the left ventricular longitudinal strain in normal subjects, categorized into systole, early diastole, and end diastole. A striking symmetry and close interrelation between atrial and ventricular strain are evident throughout the illustration. At the heart of the figure, the reciprocal interaction between atrial and ventricular dynamics during the cardiac cycle is showcased, influencing the AV plane excursion. This intricate interplay results in the transfer of volumes between the two chambers, a process central to understanding the complex mechanics of the cardiovascular system. 2DS, two-dimensional speckle tracking; AV, atrioventricular.

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  Fig. 2.. Doppler and strain measures of diastolic function. In the figure, Doppler and strain measures of diastolic function are summarized. On the top of the figure, the left atrial (dotted lines) and ventricular (continue line) pressures are represented in normal subject (left), in patients with diastolic dysfunction (middle figure) and in those with atrial fibrillation (right). For each of these groups pulsed and tissue Doppler, and atrial two dimensional strain are also shown. The behavior of the combined measures in the different groups is reported at the bottom of the figure. 2DS, two-dimensional speckle tracking; A, late diastolic wave at pulsed Doppler; a’, late diastolic wave at tissue Doppler; E, early diastolic wave at pulsed Doppler; e’, early diastolic wave at pulsed Doppler; E/e’, ratio between E and e’; E/LAr, ratio between E and LAr; LAcd, left atrial conduit at two-dimensional speckle tracking analysis; LAct, left atrial contraction at two-dimensional speckle tracking analysis; LAr, left atrial reservoir at two-dimensional speckle tracking analysis; LAr/Ee’, ratio between LAr and E/e’; s’, annulus peak systolic velocity; TDI, Tissue Doppler Imaging.

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  Fig. 3.. Echocardiographic measures of diastolic function. In the figure, echocardiographic assessment of diastolic function by Doppler and strain measures of diastolic function is summarized. Both single and combined measures are represented. 2DS, two dimensional speckle tracking analysis; E, early diastolic wave at pulsed Doppler; e’, early diastolic wave at pulsed Doppler; E/e’, ratio between E and e’; E/LAr, ratio between E and LAr; LAcd (LAScd-CD), left atrial conduit at two-dimensional speckle tracking analysis; LAct (LASct-ED), left atrial contraction at two-dimensional speckle tracking analysis; LAr (LASr-ED), left atrial reservoir at two-dimensional speckle tracking analysis; LAr/Ee’, ratio between LAr andf E/e’; TDI, Tissue Doppler Imaging.