Left atrial volume stress echocardiography in chronic coronary syndromes

Abstract Background An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify LAVI within minutes. Purpose To assess the feasibility and functional correlates of LAVI-stress echocardiography (SE) Methods Out of 514 subjects referred to 10 quality-controlled labs, LAVI-SE was completed in 490 (359 male, age 67±12 yrs, ejection fraction 60±10%) with suspected or known chronic coronary syndromes (n=462) or asymptomatic controls (n=28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAVI was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. In a single center sub-study in 50 subjects, including 28 controls and 22 patients, also peak longitudinal atrial strain (PALS, %) was measured as an index of LA reservoir function. Results The intra-observer and inter-observer LAVI variability were 5% and 8%, respectively. Δ-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r=−0.271, p<0.001), heart rate reserve (r=−0.239, p<0.001), and Δ-PALS (n=50, r=−0.374, p=0.007).LAVI-dilators were defined as those with stress-rest increase ≥6.8 ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAVI dilation (see figure) occurred in 56 patients (11%). At multivariable logistic regression analysis, B-lines ≥2 (OR: 2.586, 95% CI =1.1293–5.169, p=0.007) and abnormal left ventricular contractile reserve (OR: 2.207, 95% CI=1.111–4.386, p=0.024) were associated with LAVI dilation. Conclusion LAVI-SE is feasible, with high success rate and low variability, in patients with chronic coronary syndromes. A wet (increased B-lines) and weak (reduced LV contractile reserve and LA reservoir function) heart frequently portends LAVI dilation during stress. Figure 1 Funding Acknowledgement Type of funding source: None

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Functional correlates of left atrial volume dilatation during vasodilator stress echocardiography

European Heart Journal ◽

10.1093/ehjci/ehaa946.0015 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Prota ◽

Q Ciampi ◽

L Cortigiani ◽

E Campagnano ◽

D Morrone ◽

...

Keyword(s):

Heart Rate ◽

Left Atrial ◽

Stress Echocardiography ◽

Left Atrial Volume ◽

Peak Stress ◽

Left Ventricular ◽

Vasodilator Stress ◽

Volume Index ◽

Atrial Volume ◽

B Lines

Abstract Background Exercise and dobutamine stress may induce acute left atrial volume index (LAVI) dilatation in 1 out 10 patients. The effect of vasodilator stress in LAVI remains unknown. Purpose To assess the feasibility and functional correlates of LAVI change during dipyridamole stress echocardiography (SE). Methods We studied 149 patients (99 male, age 66±10 years, ejection fraction 59±8%, 64 with previous myocardial infarction), who underwent dipyridamole ABCDE-SE. LAVI was measured with the biplane disk summation method at rest and peak stress: LAVI-dilators were defined as those with stress-rest increase ≥6.8 ml/m2. Criteria for abnormal response of ABCDE-SE were: stress-induced changes in regional wall motion abnormalities (RWMA) for step A; B-lines at peak stress ≥2 for step B (4-site simplified scan, each site scored from 0= A-lines or black lung to 10= white lung for coalescing B-lines); reduced left ventricular contractile reserve (LVCR, peak/ rest based on force) ≤1.1 for step C; abnormal coronary flow velocity reserve (CFVR) ≤2.0, assessed by pulsed wave Doppler sampling in left anterior descending coronary artery for step D; abnormal heart rate reserve (HRR, peak/rest heart rate) ≤1.22 for step E. Results LAVI dilation occurred in 13 patients (9%). The positivity was for step A: RWMA in 6 pts (4%); step B: presence of peak B-lines in 12 pts (8%); step C: abnormal LCVR in 14 pts (9%); step D: reduced CFVR in 17 pts (11%) and step E: abnormal HRR in 46 pts (31%). LAVI dilators showed significantly higher incidence of positivity of steps A-B-C-D (see figure) compared to patients without LAVI dilatation. Conclusion Evaluation of LAVI change during vasodilator SE is feasible, and LAVI dilatation is more frequently found with ischemic (step A), wet (step B), weak (step C) and cold (step D) heart. Figure 1 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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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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P1518 Relationship between post-operative asymptomatic status and reverse remodeling of large left atrium in patients with aortic stenosis who underwent aortic valve replacement

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.942 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

T Hozumi ◽

J Morimoto ◽

T Nishi ◽

K Takemoto ◽

S Fujita ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Atrial ◽

Left Atrial Volume ◽

Left Ventricular ◽

Volume Index ◽

Reverse Remodeling ◽

Atrial Volume

Abstract Introduction Recently, we have reported that large left atrial volume (minimum left atrial volume index : LAVImin ≥30ml/m²) at end-diastole determined by direct exposure of left ventricular (LV) end-diastolic pressure can predict post-operative symptomatic status after aortic valve replacement (AVR) in aortic stenosis (AS) patients with high sensitivity and modest specificity. Reverse remodeling of large LAVImin after AVR may contribute to false positive for the prediction of post-operative symptomatic status in patients with AS. Purpose The purpose of this study was to evaluate relationship between post-operative symptomatic status and reverse remodeling of large LAVImin in patients with AS who underwent AVR. Methods The study population consisted of 75 patients with AS who underwent AVR and were followed up for 600 days after AVR, after the exclusion of the followings; atrial fibrillation, significant coronary artery disease, significant mitral valve disease, pacemaker rhythm, and inadequate echocardiographic images. We measured LAVImin by biplane Simpson"s method before and after AVR. Preoperative large LAVImin (≥30ml/m²) according to the previous study was observed in 32 (43%) of 75 patients. We divided these 32 patients into two groups according to the post-operative symptomatic status during the follow-up period. Results There was no significant difference in pre-operative LAVImin between patients with and without post-operative symptom (46.5 ± 13.4 vs 40.4 ± 8.6 ml/m²). On the other hand, post-operative LAVImin in patients without post-operative symptom was significantly smaller than that in patients with post-operative symptom (31.5 ± 8.6 vs 54.8 ± 14.0 ml/m², p < 0.01). While significant regression in LAVImin after AVR was observed in patients without post-operative symptom (40.4 ± 8.6 to 31.5 ± 8.6 ml/m², p < 0.05), no regression in LAVImin after AVR was observed in patients with post-operative symptom (46.5 ± 13.4 to 54.8 ± 14.0 ml/m²). Conclusions Reverse remodeling of large LAVmin in patients with AS who underwent AVR was observed in post-operative asymptomatic group, but not in symptomatic group. These results suggest that reverse remodeling of large LAVImin after AVR could contribute to the post-operative asymptomatic status in patients with AS who underwent AVR.

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