scholarly journals 0556: Left atrial strain is a powerful predictor of pulmonary hypertension in patients with severe aortic stenosis

2016 ◽  
Vol 8 (1) ◽  
pp. 57
Author(s):  
Jean-Christophe Eicher ◽  
Nobila Valentin Yameogo ◽  
Ludwig Serge Aho ◽  
Jean-Luc Philip ◽  
Vincent Humeau ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Left Atrial ◽  
Severe Aortic Stenosis ◽  
Powerful Predictor ◽  
Left Atrial Strain ◽  
Atrial Strain

Correlation between Left Atrial Volume Index and Pulmonary Hypertension in Patient with Moderate to Severe Aortic Stenosis

2020 ◽  
Vol 103 (8) ◽  
pp. 824-828
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Left Atrium ◽  
Left Atrial ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Left Atrium Volume

Background: Left atrial dilatation is a response to pressure overload in aortic stenosis (AS). Objective: To study the correlation between left atrium volume index (LAVI) and the pulmonary hypertension in patients with moderate to severe AS. Materials and Methods: The authors retrospectively studied patients with moderate to severe AS (either one or all echocardiographic criteria of aortic valve area [AVA]) smaller than 1.5 cm², AV Vmax of more than 3 m/s, AV mean PG of more than 30 mmHg who underwent transthoracic echocardiography at Pranangklao Hospital between January 2015 and December 2019. Results: One hundred thirty-four patients (age 72.31±12.32 years, 46.3% male) were enrolled. In pulmonary hypertension group, proportion of atrial fibrillation (75%) were significantly higher Sinus Rhythm (26.3%). Right ventricular systolic pressure (RVSP) tended to increase when LAVI increased (r=0.695, p<0.001). The mean RVSP in four groups of LAVI (less than 35 ml/m², 35 to 41 ml/m², 42 to 48 ml/m², and more than 48 ml/m²) were 35.11±8.97, 38.22±11.71, 39.0±8.57, and 60.05±31 mmHg, respectively. RVSP in patients with LAVI of more than 48 ml/m² was significantly higher than those of the other group (p<0.001). LAVI in patients with RVSP of less than 50 and more than 50 mmHg were 35.13±6.86 and 65.22±11.55 ml/m², respectively (p<0.001). Conclusion: Moderate to severe AS, RVSP increase when LAVI increases. Keywords: Echocardiography, Left atrium volume index, Aortic stenosis, Pulmonary hypertension

P2452Application of left atrial strain for differentiation between pre- and post-capillary pulmonary hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Inoue ◽  
E W Remme ◽  
F H Khan ◽  
O S Andersen ◽  
E Gude ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Atrial ◽  
Vena Cava ◽  
Invasive Procedure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Left Atrial Strain ◽  
Chamber View ◽  
Pulmonary Capillary ◽  
Atrial Strain

Abstract Background Pulmonary hypertension (PH) is classified as pre- or post-capillary PH, and pulmonary capillary wedge pressure (PCWP) >15 mmHg is used as criterion for post-capillary PH. Elevated left atrial (LA) pressure is associated with reduced LA reservoir strain. Thus, LA strain may potentially serve to differentiate between these diagnoses. Objectives This study tested the hypothesis that LA strain can be used as a noninvasive parameter to differentiate between pre- and post-capillary PH. Methods We analyzed 103 patients (mean age: 58 years, 51 female) referred to right heart catheterization due to unexplained dyspnea or suspected heart failure. Echocardiography was performed within 24 hours of the invasive procedure. Mean pulmonary artery pressure (PAP) was noninvasively estimated from tricuspid regurgitation (TR) velocity and inferior vena cava (IVC) diameter and collapsibility. LA reservoir strain was calculated from apical four-chamber view by speckle tracking echocardiography, and was feasible in 101 patients. Results Twenty-eight patients were invasively confirmed with pre-capillary PH and 43 patients with post-capillary PH. The remaining 32 patients had no PH. LA reservoir strain was significantly lower in patients with post-capillary PH than patients with pre-capillary PH (9.9±5.5% vs. 24.6±8.2%, p<0.01). At a cut-off value of 15.4%, LA reservoir strain could predict elevated PCWP >15 mmHg with AUC=0.88, sensitivity=84.8% and specificity=81.8%. As shown in the figure, echocardiography with LA reservoir strain correctly differentiated 82% of patients into pre- and post-capillary PH. Conclusions These results suggest that LA reservoir strain can be used to predict elevated PCWP, thus allowing discrimination between pre- and post-capillary PH.

scholarly journals Left atrial emptying fraction: a powerful predictor of events in severe aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Goncalves ◽  
J Ferreira ◽  
J Almeida ◽  
A Freitas ◽  
R Martins ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Clinical Outcomes ◽  
Prognostic Marker ◽  
Left Atrial ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Powerful Predictor ◽  
Maximum Volume ◽  
Patient Groups

Abstract Background Increasing evidence suggests that left atrial (LA) structural and functional changes have an important role in risk stratification and prediction of clinical outcomes. We know from multiple data that left atrial maximum volume (LAVI), measured at end-systole, is a powerful prognostic marker in multiple patient groups. However, recent studies have suggested that this marker may not be the best representative of diastolic function as it does not image the full spectrum of atrial mechanics. Another measure of LA function is the left atrial emptying fraction (LAEF), which has proved to be a significant prognostic marker in many patient groups. Less known is its role in event prediction in severe aortic stenosis patients, a disease with a very important burden in modern societies. Purpose The authors hypothesised that LAEF is a powerful predictor of clinical outcomes at 1 year in patients with severe aortic stenosis. Methods We retrospectively evaluated 151 patients referred to our echocardiography laboratory with the diagnosis of severe aortic stenosis. All patients underwent transthoracic echocardiography. LA maximum volume was indexed to body surface area. LAEF was calculated as LAVI-LA minimum volume divided by LAVI. Patients were followed for 1 year regarding clinical outcomes. Clinical outcome was defined as a composite of hospital admission for a cardiovascular (CV) cause, emergency department recurrence for a CV cause or CV death. Logistic binary regression was used to evaluate associations of LAEF with the outcome. Results A total of 51.7% of patients (n=78) were males. Mean patient age was 76.6±8.0 years. A total of 38.4% of patients were diabetics (n=56), 96% had dyslipidaemia (n=145) and 25% (n=37) had atrial fibrillation. Mean left ventricular ejection fraction (LVEF) was 60.6±7.3, and mean LAVI was 41.4±12.1. In a multivariable regression model including clinical and echocardiographic markers, higher LAVI and pulmonary artery systolic pressure (PASP) were associated with lower LAEF. Receiver operating characteristic curve analysis showed that the predictive value of LAEF for outcomes at 1 year was 0.693 (AUC=0.693, CI 95% 0.578–0.809, p=0.002), performing better than other echocardiographic markers such as LAVI (AUC=0.567, CI 95% 0.440–0.694, p=0.286), PASP (AUC=0.582, CI 95% 0.451–0.714, p=0.191) and LVEF (AUC=0.590, CI 95% 0.464–0.716, p=0.153). After adjustment of baseline characteristics, a LAEF less than 41.3% remained a good predictor of clinical outcomes at 1 year (OR 2.615, CI 95% 1.085–6.305, p=0.32). Conclusions In this cohort of severe aortic stenosis patients, a reduced LAEF was associated with greater incidence of cardiovascular events, being a stronger predictor than LAVI, PASP or LVEF. This study suggests that LA dysfunction over LA volumes correlates better with clinical outcomes. Funding Acknowledgement Type of funding source: None

Left atrial deformation in estimating left atrial pressure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Lindqvist ◽  
E Tossavainen ◽  
M.Y Henein
Keyword(s):  
Pulmonary Hypertension ◽  
Strain Rate ◽  
Left Atrial ◽  
Right Heart Catheterization ◽  
Left Ventricular ◽  
Valve Disease ◽  
Heart Catheterization ◽  
Clinical Value ◽  
Left Atrial Strain ◽  
Atrial Strain

Abstract Background In the absence of mitral valve disease, elevated left atrial (LA) pressure reflects reduced left ventricular (LV) compliance and raised diastolic pressures, hence an important explanation for exertional breathlessness. Methods We studied 145 symptomatic patients, age 63±14 years, 55 males, using conventional transthoracic echocardiography guidelines protocol, including LA and LV myocardial deformation investigations along with simultaneous right heart catheterization using conventional techniques. From invasive measurements, pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP) were measured and pulmonary vascular resistance (PVR) calculated. No patient had more than mild mitral or aortic valve disease. Results LA strain rate during atrial systole (LASRa) was the strongest correlate with PCWP (r2=−0.39, p&lt;0.001), over and above LASR during LV systole (LASRs) and peak LA longitudinal strain (PALS) (r2=−0.21 and −0.19, respectively, p&lt;0.001 for both). Both LASRa and PALS predicted elevated PCWP &gt;15 mmHg but only modestly (AUC= 0.55 and 0.52). The relationship between LASRa and PCWP was stronger in patients with post-capillary pulmonary hypertension compared to those with pre-capillary pulmonary hypertension (r2=0.21 vs. r2=0.02). However, the strongest relationship between LASRa and PCWP was in patients with LA volume &gt;34 ml/m2 (r2=0.59, p&lt;0.001, see figure) but other strain relationships did not improve after only including patients with increased LA volume. Finally, LASRa correlated modestly with the respective LVSRa (r=0.53, P&lt;0.01), and to lesser extent with other cavity interaction correlations (r=0.26–0.48, p&lt;0.01). Conclusion Despite being somehow related to ventricular function, left atrial strain rate during atrial contraction is the closest correlate to PCWP, particularly in patients with dilated LA cavity. These data should be of significant clinical value in daily management of symptomatic patients. LASRaecho and PCWPrhc in patients with d Funding Acknowledgement Type of funding source: None

scholarly journals MRI feature tracking strain in pulmonary hypertension: utility of combined left atrial volumetric and deformation assessment in distinguishing post- from pre-capillary physiology

2021 ◽  
Author(s):  
Kai'En Leong ◽  
Luke Howard ◽  
Francesco Lo Guidice ◽  
Holly Pavey ◽  
Rachel Davies ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Atrial ◽  
Feature Tracking ◽  
Cross Sectional Study ◽  
Right Atrial ◽  
Peak Strain ◽  
Sectional Study ◽  
Left Atrial Strain ◽  
Cross Sectional ◽  
Atrial Strain

Abstract AimsPulmonary hypertension (PH) is dichotomized into pre- and post-capillary physiology by invasive catheterization. Imaging, particularly strain assessment, may aid in classification and be helpful with ambiguous haemodynamics. We sought to define cardiac MRI (CMR) feature tracking biatrial peak reservoir and biventricular peak systolic strain in pre- and post-capillary PH and examine the performance of peak left atrial strain in distinguishing the 2 groups compared to TTE.Methods and resultsRetrospective cross-sectional study from 1 Jan 2015 to 31 Dec 2020; 48 patients (22 pre- and 26 post-capillary) were included with contemporaneous TTE, CMR and catheterization. Mean pulmonary artery pressures were higher in the pre-capillary cohort (55 + 14 mmHg vs 42 + 9 mmHg; p<0.001) as was pulmonary vascular resistance (median 11.7 WU vs 3.7 WU; p<0.001). Post-capillary patients had significantly larger left atria (60 + 22 ml/m2 vs 25 + 9 ml/m2; p<0.001). There was no difference in right atrial volumes between groups (60 + 21 ml/m2 vs 61 + 29 ml/m2; p=0.694), however peak RA strain was lower in post-capillary PH patients (8.9 + 5.5% vs 18.8 + 7.0%; p<0.001). In the post-capillary group, there was commensurately severe peak strain impairment in both atria (LA strain 9.0 + 5.8%, RA strain 8.9 + 5.5%). CMR LAVi and peak LA strain had a multivariate AUC of 0.98 (95% CI 0.89-1.00; p<0.001) for post-capillary PH diagnosis which was superior to TTE.ConclusionCMR volumetric and deformation assessment of the left atrium can highly accurately distinguish post- from pre-capillary PH.

Sign in / Sign up

Export Citation Format

Share Document