Left atrial strain reservoir in monitoring heart transplant paediatric patients

Abstract Funding Acknowledgements Type of funding sources: None. Background In heart transplant (HT) patients, high LV filling pressure is considered a marker of rejection and predictive of increased mortality. Purpose Our study aims to correlate echocardiographic parameters to left-ventricular end diastolic pressure (LVEDP) at cardiac catheterization in transplant recipients. Methods This was a retrospective study of 50 HT patients (54% male) who underwent heart transplantation in paediatric age (0-18 years-old). The echocardiographic evaluation was performed within three weeks from the left heart cardiac catheterization. From apical view, we measured: left atrial strain (LAS) indices [atrial contraction (εac), LA filling (reservoir phase, εres), and LA passive emptying (conduit phase, εcon)], mitral doppler E/A, E/e’, global longitudinal strain (LVGLS) and strain rate. Results Median LVEDP was 10 mmHg (IQR 8.25-12 mmHg) and had the best correlation with decreased εres (r= -0.56, p < 0.0001). The other LAS indices and mitral E/e’ correlated less strongly with LVEDP (εac: r= -0.42, p = 0.004; εcon: r= -0.55, p= 0.0001; E/e’: r = 0.28, p = 0.04). E/A, LVGLS and LVGLS rate did not correlate with LVEDP. By ROC analysis, εres ≤ 16.3% was predictive of elevated LVEDP with a good sensitivity (86%) and moderate specificity (57%). A multivariate analysis produced εres as the best predictor (p = 0.0001) for high LVEDP. Conclusions Non-invasive εres seems to be a good surrogate of invasive LVEDP. Monitoring εres may be of value in HT patients to survey for rejection and graft disfunction. Abstract Figure. Scatter plots LVEDP-εres correlation

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Correlation of Left Atrial Strain and Doppler Measurements with Invasive Measurement of Left Ventricular End-Diastolic Pressure in Patients Stratified for Different Values of Ejection Fraction

Echocardiography ◽

10.1111/echo.13094 ◽

2015 ◽

Vol 33 (3) ◽

pp. 398-405 ◽

Cited By ~ 66

Author(s):

Matteo Cameli ◽

Stefania Sparla ◽

Maurizio Losito ◽

Francesca M. Righini ◽

Daniele Menci ◽

...

Keyword(s):

Ejection Fraction ◽

Left Atrial ◽

Diastolic Pressure ◽

Left Ventricular ◽

Left Atrial Strain ◽

Atrial Strain ◽

Invasive Measurement

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Comparing the Performance of Tissue Doppler versus Left Atrial Strain in Predicting Left Ventricular End Diastolic Pressure in Patients with Different Left Ventricular Ejection Fractions

Sohag Medical Journal ◽

10.21608/smj.2018.41318 ◽

2018 ◽

Vol 22 (1) ◽

pp. 213-221

Author(s):

Aliaa Mahfouz ◽

Mohammed Salama ◽

Ramadan Mohamed ◽

Mohamed Saleh

Keyword(s):

Left Atrial ◽

Diastolic Pressure ◽

Tissue Doppler ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Left Atrial Strain ◽

Atrial Strain

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Left atrial strain in cardiac amyloidosis

European Heart Journal ◽

10.1093/eurheartj/ehab724.1794 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Aimo ◽

I Fabiani ◽

V Spini ◽

V Chubuchny ◽

E M Pasanisi ◽

...

Keyword(s):

Cardiac Amyloidosis ◽

Longitudinal Strain ◽

Systolic Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Atrial Strain ◽

Funding Sources ◽

Atrial Contraction ◽

Amyloid Light Chain ◽

Atrial Strain

Abstract Background Patients with cardiac amyloidosis (CA) display an enlarged and dysfunctional left atrium (LA), because of the effects of left ventricular (LV) diastolic and then systolic dysfunction, as well as the amyloid infiltration of LA wall. A single study reported impaired LA strain in CA, but differences among amyloid light-chain (AL) and transthyretin (ATTR) CA and the correlates of reduced LA strain have not been characterized. Methods We evaluated 426 consecutive patients undergoing a screening for suspected CA in 2 tertiary referral centres. Among them, 262 (61%) were diagnosed with CA (n=117 AL-CA, n=145 ATTR-CA). We measured peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) from 4- and 2-chamber (4C, 2C) views, and correlated them with maximum and minimum LA volumes, E/e' ratio, and LV global longitudinal strain (GLS). Results LA strain was much more severely impaired in patients with ATTR-CA than those without CA, and to a lesser extent than those with AL-CA (Figure). LA volumes were larger in patients with ATTR-CA than those without CA (maximal LA volume, p=0.042; minimal LA volume, p<0.001), and those with AL-CA (both volumes, p<0.001). LA strain values were more closely correlated with minimal than maximal LA volumes, and patients with AL-CA displayed stronger correlations than those with ATTR-CA or without CA; for example, Spearman's rho values for 4C-PALS vs. minimal LA volume were 0.595, 0.481, and 0.462, respectively (all p<0.001). Furthermore, LA strain correlated with E/e' in patients with AL-CA, but not in those with ATTR-CA: 4C-PALS vs. E/e', rho 0.406, p=0.001 (AL-CA), p=0.401 (ATTR-CA), and p=0.097 (no CA). Finally, LA strain correlated most closely with LV GLS in patients with AL-CA: 4C-PALS vs. LV GLS, rho 0.431, p<0.001 (AL-CA), rho 0.401, p<0.001 (ATTR-CA), rho 0.219, p=0.042 (no CA). Conclusions LA volume increase and reduced LA strain is particularly prominent in patients with ATTR-CA. Patients with AL-CA seem to display closer relationships between LA strain, size and haemodynamic load, possibly reflecting the most acute disease course, and lower time for amyloid deposition in the LA wall. FUNDunding Acknowledgement Type of funding sources: None.

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Correlation of left atrial strain with left ventricular end-diastolic pressure in patients with normal left ventricular ejection fraction

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-020-01869-7 ◽

2020 ◽

Vol 36 (9) ◽

pp. 1659-1666 ◽

Cited By ~ 1

Author(s):

Jia-Li Fan ◽

Bo Su ◽

Xin Zhao ◽

Bing-Yuan Zhou ◽

Chang-Sheng Ma ◽

...

Keyword(s):

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Left Atrial ◽

Diastolic Pressure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Left Atrial Strain ◽

Ventricular Ejection Fraction ◽

Normal Left Ventricular ◽

Atrial Strain

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Left Ventricular Strain and Left Atrial Strain Are Impaired During Hemodialysis in Children

10.21203/rs.3.rs-311082/v2 ◽

2021 ◽

Author(s):

Tam T Doan ◽

Poyyapakkam Sriva ◽

Asela Liu ◽

J. Kevin Wilkes ◽

Alexandra Idrovo ◽

...

Keyword(s):

Left Atrial ◽

Cardiovascular Health ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Atrial Strain ◽

Left Ventricular Strain ◽

Mechanical Dispersion ◽

Pediatric Hemodialysis ◽

Atrial Strain

Abstract Purpose We aimed to investigate intradialytic changes in ventricular and atrial function using speckle tracking echocardiography (STE) in pediatric hemodialysis (HD). Methods Children with HD vintage > 3 months were enrolled, and echocardiography was performed prior to, during, and after HD. STE was analyzed using GE EchoPAC. Left ventricular (LV) global longitudinal strain (GLS), strain rate (Sr), and mechanical dispersion index (MDI) were calculated as the average from 3 apical views; diastolic strain (Ds) and Sr from 4-chamber tracing; left atrial strain (LAS) and Sr from the 4- and 2-chamber views. Results A total of 15 patients were enrolled at a median age of 12 years (IQR 8, 16) and median HD vintage of 13 months (IQR 9, 25). GLS worsened during HD (-15.8 ± 2.2% vs -19.9 ± 1.9%, p < 0.001). Post-HD GLS was associated with BP decrease (coefficient = 0.62, p = 0.01). LV MDI and systolic Sr did not change. LV Ds progressively worsened (-8.4% (-9.2, -8.0) vs − 11.9% (-13.4, -10.3), p < 0.001). LAS changes at mid-HD returned to baseline post-HD. Ds, DSr, LAS, LASr were not associated with BV removal or BP decrease (p > 0.1). Conclusions Intradialytic LV strain and LAS changes consistent with subclinical systolic and diastolic dysfunction were observed during HD in children. Changes in Ds, DSr, LAS, and LASr were not associated with BP change or BV removal and may be related to the disease progression. Longitudinal study using these novel indices may unfold the effect of these subclinical changes on long-term cardiovascular health in children requiring chronic HD.

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Utility of left atrial strain imaging for the determination of diastolic dysfunction in patients with STEMI

European Heart Journal ◽

10.1093/eurheartj/ehab724.038 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

K Ohtaroglu Tokdil ◽

Z Ongen ◽

B Ikitimur ◽

E Durmaz ◽

H Tokdil ◽

...

Keyword(s):

Myocardial Infarction ◽

Diastolic Dysfunction ◽

Left Atrial ◽

Diastolic Pressure ◽

Strain Imaging ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Left Atrial Strain ◽

Group 2 ◽

Atrial Strain

Abstract Introduction Since echocardiographic parameters indicating increased left ventricular filling pressure were validated in patients with stable coronary artery disease and patients with acute coronary syndrome were excluded, the utility of these parameters in ACS patients is not clarified. Recent studies suggest that left atrial strain imaging is a reliable method for the assessment of left ventricular diastolic dysfunction. Purpose In this study, we aimed to investigate the clinical utility of left atrial strain imaging for the detection of increased LVFP. Methods We prospectively included patients diagnosed with ST-segment elevation myocardial infarction who were treated with primary percutaneous intervention (pPCI). Left ventricular end-diastolic pressure was measured following the procedure. Comprehensive echocardiographic evaluation was performed within 24 hours of pPCI. Patients with atrial fibrillation and severe valvular heart disease were excluded. Normal LV end-diastolic pressure was accepted as <18 mmHg. Results 76 patients were enrolled. Patients were divided into two groups according to LVEDP value. Group 1 patients included patients with normal LVEDP (42 patients) and the rest of the patients included into group 2 (27 patients). Comorbidities including hypertension (p: 0.408), diabetes (p: 0.696) and dyslipidaemia (p: 0.336) were similar between groups. Anterior myocardial infarction was more prevalent in group 2 patients (p: 0.012). Troponin and pro-BNP values were significantly higher in group 2 patients (p: 0.001 and p: 0.03 respectively). Left ventricular ejection fraction and left ventricular global strain values were significantly lower in group 2 patients (p: 0.048 and p: 0.025 respectively). Table 1 represents the comparison of strain values between groups. Left atrial reservoir strain rates were lower in group 2 patients (p: 0.09). Correlation analyses revealed that there is a statistically significant relationship between left atrial strain values and LVEDP (p: 0.003 and r: 0.238). Conclusion In conclusion, our study has demonstrated that left atrial strain imaging is a useful non-invasive method for the assessment of increased LVEDP in patients with STEMI. FUNDunding Acknowledgement Type of funding sources: None. Echocardiographic variables

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Abstract 15681: Reduced Left Atrial Strain is Associated With the Development of Atrial Arrhythmias in Hospitalized Patients With COVID-19

Circulation ◽

10.1161/circ.142.suppl_3.15681 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Erin Goerlich ◽

Anum S Minhas ◽

Andreas S Barth ◽

Katherine C Wu ◽

Allison G Hays

Keyword(s):

Ejection Fraction ◽

Left Atrial ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Hospitalized Patients ◽

Inpatient Setting ◽

Atrial Arrhythmias ◽

Contributing Factors ◽

Left Atrial Strain ◽

Atrial Strain

Introduction: Coronavirus Disease 2019 (COVID-19) is a pandemic with frequent cardiovascular (CV) complications, including cardiac arrhythmias. However, little is known about contributing factors to the development of new atrial tachyarrhythmias (ATs) in the inpatient setting. Left atrial strain (LAS) is a novel transthoracic echocardiography (TTE) measure of LA myocardial deformation and predicts arrhythmias. We aimed to compare clinical and echocardiographic variables including LAS in hospitalized patients with COVID-19 who developed new ATs compared to matched controls without arrhythmias. Methods: We retrospectively studied 42 patients hospitalized with COVID-19 who underwent clinical TTE. During admission, 20 patients without prior arrhythmia developed new ATs (including sustained atrial fibrillation/flutter/tachycardia, and undifferentiated supraventricular tachycardia) (cases) and were compared to 22 age and sex-matched COVID-19 patients without arrhythmias (controls). TTEs were analyzed for reservoir (peak longitudinal) LAS using 2D-speckle tracking and LA ejection fraction (LAEF) offline using TomTec software. Comparisons were made using Chi-square and t-tests as appropriate. Results: Mean age was 65±14 years, and 40% were women. There were no significant differences in CV risk factors, BMI, troponin or peak inflammatory markers between cases and controls. LAS was overall lower than normal and significantly lower in cases compared to controls (23.5±7.5% vs 31.0±6.0% respectively, P =0.001; Fig 1). There were no significant differences in left ventricular (LV) ejection fraction (LVEF), LV global longitudinal strain (GLS), LAEF, shock or death. Conclusions: COVID-19 patients who developed new ATs have lower LAS on TTE than patients without atrial arrhythmias. LAS may be a sensitive marker for identifying patients with COVID-19 at risk for ATs compared to LVEF, LV GLS, and LAEF. Larger confirmatory studies are warranted.

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Left Ventricular Strain and Left Atrial Strain Are Impaired During Hemodialysis in Children

10.21203/rs.3.rs-311082/v1 ◽

2021 ◽

Author(s):

Tam T Doan ◽

Poyyapakkam Sriva ◽

Asela Liu ◽

J. Kevin Wilkes ◽

Alexandra Idrovo ◽

...

Keyword(s):

Left Atrial ◽

Global Longitudinal Strain ◽

Secondary Analysis ◽

Left Ventricular ◽

Chronic Hemodialysis ◽

Longitudinal Assessment ◽

Cardiac Events ◽

Left Atrial Strain ◽

Mortality And Morbidity ◽

Atrial Strain

Abstract Background Cardiac mortality and morbidity remain significant in children on chronic hemodialysis (HD). Multiple markers by speckle tracking echocardiography (STE) are predictive of cardiac events in adults, but data in children are limited; ventricular diastolic strain (Ds) and left atrial strain (LAS) have not been reported. The aim of this study was to investigate intradialytic changes in ventricular and atrial function using STE in children. Methods Secondary analysis of a prospective descriptive study of children with structurally normal hearts and HD vintage > 3 months, using echocardiography performed prior to, during, and after HD. STE was analyzed using GE EchoPAC. Left ventricular (LV) global longitudinal strain (GLS), strain rate (Sr), and mechanical dispersion index (MDI) were calculated as the average from 3 apical views; Ds and Sr were obtained from 4-chamber tracing; LAS and Sr were assessed during atrial contraction, reservoir, and conduit. Intradialytic changes in 2D STE markers of ventricular function and LAS and their association with blood volume (BV) removal and blood pressure (BP) change were studied. Results A total of 15 children were enrolled at a median age of 12 years (IQR 8, 16) and median HD vintage of 13 months (IQR 9, 25). GLS was impaired during HD (-15.8 ± 2.2% vs -19.9 ± 1.9%, p < 0.001). Post-HD GLS was associated mean BP decrease (coefficient = 0.62, p = 0.01) and not with BV removal (coefficient = 0.49, p = 0.06). LV MDI and systolic Sr did not change. LV Ds was progressively impaired (-8.4% (-9.2, -8.0) vs − 11.9% (-13.4, -10.3), p < 0.001). LAS conduit and reservoir worsened at mid-HD and returned to baseline post-HD. Changes in Ds, DSr, LAS, LASr were not associated with BV removal or BP decrease (p > 0.1). Conclusions Intradialytic LV strain and LAS impairment consistent with subclinical systolic and diastolic dysfunction were observed during HD in children. GLS impairment was associated with BP change, but changes in Ds, DSr, LAS, and LASr were not associated with BP change or BV removal. Longitudinal assessment using these novel non-invasive indices may unfold the effect of cumulative subclinical changes on long-term outcomes in children who are on chronic HD.

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