Potential Usefulness and Clinical Relevance of Adding Left Atrial Strain to Left Atrial Volume Index in the Detection of Left Ventricular Diastolic Dysfunction

Abstract Introduction Heart failure with reduced ejection fraction (HFrEF) is associated with significant morbidity and mortality. Recently, in the PARADIGM-HF, sacubitrilvalsartan was superior to enalapril in reducing death and hospitalization for heart failure, and there is a growing interest in determining the structural changes besides reverse left ventricular remodelling. Purpose To determine if, in patients treated with sacubitril-valsartan, there was a change in left atrial (LA) mechanics quantified by two-dimensional strain echocardiography (2D-STE). Methods A total of 38 consecutive patients with HFrEF, followed in an outpatient heart failure clinic, were recruited. Population characteristics are summarized in Table 1. 2D-STE was used to measure left atrial strain in the reservoir phase (LASr) (Figure 1) and strain rate (LA-SR) before and 3 months after initiation of sacubitril-valsartan. Results There was a significant improvement in LASr (11.3±6.5% vs 14.2±7.4%, p=0.006) and LA-SR (0.55±0.25 s-1 vs 0.69±0.31 s-1, p=0.008) after initiation of sacubitril-valsartan. There was also a significant reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (1443.5 pg/ml (Interquartile range [IQR], 772–2912) vs 1112.0 pg/ml (IQR, 510–1455), p=0.016) and a tendency towards reduction in left atrial volume index (LAVI) (54.6±17.0 ml/m2 vs 51.4±18.8 ml/m2, p=0.053). The change in LASr and LA-SR was not related with the dose of sacubitril-valsartan (p=0.089). Conclusion In this population of HFrEF patients LA mechanics, as determined by 2D-STE, as well as NT-proBNP levels, significantly improved after treatment with sacubitril-valsartan. Figure 1. Left atrial strain Funding Acknowledgement Type of funding source: None

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Abstract 4205: Left Atrial Volume Index and Left Ventricular Geometry Independently Predict Mortality in 47,865 Patients with Preserved Ejection Fraction

Circulation ◽

10.1161/circ.118.suppl_18.s_843 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Dharmendrakumar A Patel ◽

Carl J Lavie ◽

Richard V Milani ◽

Hector O Ventura

Keyword(s):

Ejection Fraction ◽

Left Atrial ◽

Left Atrial Volume ◽

Left Ventricular ◽

Mortality Prediction ◽

Volume Index ◽

Left Ventricular Geometry ◽

Preserved Ejection Fraction ◽

Atrial Volume ◽

Left Atrial Volume Index

Background: LV geometry predicts CV events but it is unknown whether left atrial volume index (LAVi) predicts mortality independent of LV geometry in patients with preserved LVEF. Methods: We evaluated 47,865 patients with preserved EF to determine the impact of LAVi and LV geometry on mortality during an average follow-up of 1.7±1.0 years. Results: Deceased patients (n=3,653) had significantly higher LAVi (35.3 ± 15.9 vs. 29.1 ± 11.9, p<0.0001) and abnormal LV geometry (60% vs. 41%, p<0.0001) than survivors (n=44,212). LAVi was an independent predictor of mortality in all four LV geometry groups [Hazard ratio: N= 1.007 (1.002–1.011), p=0.002; concentric remodeling= 1.008 (1.001–1.012), p<0.0001; eccentric hypertrophy= 1.012 (1.006 –1.018), p<0.0001; concentric hypertrophy=1.017 (1.012–1.022), p<0.0001; Figure ]. Comparison of models with and without LAVi for mortality prediction was significant suggesting increased mortality prediction by addition of LAVi to other independent predictors (Table ). Conclusion: LAVi is higher and LV geometric abnormalities are more prevalent in deceased patients with preserved systolic function and are independently associated with increased mortality. LAVi predicts mortality independent of LV geometry and has synergistic influence on all cause mortality prediction in large cohort of patients with preserved ejection fraction.

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How to incorporate left atrial strain in the diagnostic algorithm of left ventricular diastolic dysfunction

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-020-02070-6 ◽

2020 ◽

Author(s):

L. F. Cerrito ◽

C. Maffeis ◽

R. M. Inciardi ◽

E. Tafciu ◽

G. Benfari ◽

...

Keyword(s):

Diastolic Dysfunction ◽

Left Atrial ◽

Diagnostic Algorithm ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Left Atrial Strain ◽

Ventricular Diastolic Dysfunction ◽

Atrial Strain

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P1486Semi-automated volume-strain loops: a new tool in TTE to assess diastolic dysfunction

European Heart Journal ◽

10.1093/eurheartj/ehz748.0251 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Hubert ◽

V Le Rolle ◽

E Galli ◽

A Hernandez ◽

E Donal

Keyword(s):

Left Atrial ◽

Global Longitudinal Strain ◽

Left Atrial Volume ◽

Left Ventricular ◽

Volume Index ◽

Atrial Volume ◽

Volume Strain ◽

Left Atrial Volume Index ◽

Loop Area ◽

Lv Volume

Abstract Aim This work aims to evaluate a novel semi-automatic tool for the assessment of volume-strain loops by transthoracic echocardiography (TTE). The proposed method was evaluated on a typical model of left ventricular (LV) diastolic dysfunction: the cardiac amyloidosis. Method 18 patients with proved cardiac amyloidosis were compared to 19 controls, from a local database. All TTE were performed using Vivid E9 or E95 ultrasound system. The complete method includes several steps: 1) extraction of LV strain full traces from apical 4 and 2 cavities views, 2) estimation of LV volume from these two traces by spline interpolations, 3) resampling of LV strain curves, determined for the same cardiac beat, (in apical 4-, 2- and 3- cavities views) as a function of pre-defined percentage increments of LV-volume and 4) calculation of the LV volume-strain loop area. (Figure 1, panel B) Results (Table 1): LVEF was similar between both groups whereas global longitudinal strain was significantly lower in amyloidosis group (−14.4 vs −20.5%; p<0.001). Amyloidosis group had a worse diastolic function with a greater left atrial volume index (51 vs 22ml/m2), a faster tricuspid regurgitation (2.7 vs 2.0 m/s), a greater E/e' ratio (17.3 vs 5.9) with a p<0.001 for all these indices. Simultaneously, the global area of volume-strain loop was significantly lower in amyloidosis group (36.5 vs 120.0%.mL). This area was better correlated with mean e' with r=0.734 (p<0.001) than all other indices (Figure 1, panel A). Table 1 Amyloidosis (N=18) Controls (N=19) p Global strain-volume loop area (%.mL) 36.5±21.3 120.0±54.2 <0.001 Global longitudinal strain (%) −14.4±3.8 −20.5±1.8 <0.001 Left ventricular ejection fraction (%) 62±7 65±5 0.08 Left atrial volume index (ml/m2) 51±22 22±5 <0.001 E/A 1.72±0.97 2.07±0.45 0.17 Mean e' 5.5±1.3 14.4±2.8 <0.001 Mean E/e' 17.3±5.4 5.9±1.4 <0.001 Tricuspid regurgitation velocity (m/s) 2.7±3.8 2.0±0.3 <0.001 Figure 1 Conclusion LV volume-strain loop area appears a very promising new tool to assess semi-automatically diastolic function. Future applications will concern the integration of LV volume-strain loop area as novel feature in machine-learning approach.

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