scholarly journals P340 New tools for the assesment of diastolic function in attr cardiac amyloidosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Gonzalez Ferrero ◽  
C A J C Abou Jokh Casas ◽  
C C A Cacho Antonio ◽  
E A J C Abou Jokh Casas ◽  
P A M Antunez Muinos ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Cardiac Amyloidosis ◽  
Predictive Ability ◽  
P Value ◽  
Peak Strain ◽  
Left Atrial Strain ◽  
Atrial Strain ◽  
Fractional Shortening ◽  
Strain Peak

Abstract INTRODUCCION Cardiac amyloidosis (CA) is a cardiomyopathy where the main disturbances are due to diastolic dysfunction. This requires a meticulous clinical and echocardiograpic evaluation. METHODS The aim of this study was to analyse the association between previously described parameters of diastolic dysfunction and others less known such as left atrial peak strain. RESULTS Thirty-six patients with suspicion of cardiac amyloidosis were submitted to DPD scintigraphyand transthoracic echocardiography, and were divided into two groups. Of these patients, eleven had no visual gammagraphic catchment whereas twenty-four, (68%) did. Median peak of atrial strain was 16.8 in sinus rhythm and 6.8% in atrial fibrillation (p < 0.0001) with no differences in the proportion of AF. Median value of the velocity of E wave in patients with no catchment was 1.17 m/s whereas in those with ATTR-CA 0.77 m/s (p= 0.004). No differences were observed in other parameters such as A wave, E/A ratio or deceleration slope of E wave. We found that the strongest predictor of high filling pressures (E/e’> 14) was systolic strain left atrial peak (p = 0,004 IC 95% 0.8-0.9) with an accurate predictive ability, AUC (76%). CONCLUSIONS Left atrial strain peak could be an interesting parameter for the assessment of diastolic dysfunction and a protective value for elevated filling pressures in CA-ATTR patients. Basal features ABSENCE OF CATCHMENT POSITIVE CATCHMENT P-value E (m/s) 0.77 1.17 0.04 A (m/s) 0.76 0.9 0.64 E/A 195 181 0.91 E/e’ 14 0.9 0.73 Atrial strain peak 8.5 11.8 0.78 35% AF 45% AF Fractional shortening (%) 34.34 31.80 0.81 Differences between both groups Abstract P340 Figure. Relationship: E/e" and atrial strain

P1482Preclinical diastolic dysfunction assessed by left atrial strain and association with incident heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Potter ◽  
S Ramkumar ◽  
H Yang ◽  
H Kawakami ◽  
K Negishi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Left Atrial ◽  
Left Ventricular ◽  
Community Dwelling ◽  
Volume Index ◽  
P Value ◽  
Left Atrial Strain ◽  
Atrial Strain

Abstract Background Left atrial strain in the reservoir phase (LASr) measures passive LA stretch and is a sensitive marker of left ventricular diastolic dysfunction (DD). However, reduced LASr has not been prospectively validated against clinical heart failure (HF) endpoints and its place in diastology evaluation is unclear. Aim We sought whether DD grades defined by previously validated ranges of LASr predicted incident HF and whether reclassifying indeterminate diastolic function based on reduced LASr could facilitate assessment of HF risk. Methods Community dwelling elderly subjects were recruited and underwent baseline clinical and echocardiographic assessment. Where imaging was suitable, speckle-tracking echocardiography assessed LASr and subjects were assigned DD grades based on published ranges: normal >35%, grade 1 24–35%, grade 2 19–24%, grade 3 <19%. Current ASE/EACVI recommendations were used to identify those with indeterminate function; LASr-defined DD (LASr-DD) was defined as LASr ≤23%. Follow-up was ≤2 years and incident HF adjudicated by Framingham criteria. Results Of 610 subjects (age 71±5 yrs., 46% male) LASr analysis was feasible in 590 (97%); average LASr was 39% (IQR 34–43%). Incident HF was associated with LASr-DD grade, occurring in 8 (36%) with grade ≥2, 14 (10%) with grade 1 and 39 (9%) with normal function (p<0.001). Adjusted odds ratio for incident HF for LASr-DD grade ≥2 was 3.12 (95% CI 1.06–9.1, p=0.038) Diastolic function was indeterminate in 147 (24%) subjects; of 144 (98%) with LAS analysis, 6 (75%) of those with LASr-DD vs. 15 (11%) with normal LASr experienced incident HF (p<0.001). Univariable Multivariable* OR (95% CI) p-value OR (95% CI) p-value LASr-DD grade:   1 1.13 (0.59–2.15) 0.7 0.84 (0.42–1.69) 0.63   ≥2 5.7 (2.26–14.5) <0.001 3.12 (1.06–9.1) 0.038 *Adjusted for age, hypertension, diabetes, BMI, global longitudinal strain, E/e', LA volume index, LV mass index (all p<0.1 on univariable analysis). Incorporating LA strain in practice Conclusion DD defined by LASr is predictive of HF for grades ≥2 independent of other diastolic measures. Indeterminate diastolic function with LASr ≤23% is associated with incident HF. LASr may complement current diastolic function assessment recommendations. Acknowledgement/Funding Baker Heart and Diabetes Institute

scholarly journals Association of Asymptomatic Diastolic Dysfunction Assessed by Left Atrial Strain With Incident Heart Failure

2020 ◽  
Vol 13 (11) ◽  
pp. 2316-2326 ◽  
Author(s):  
Elizabeth L. Potter ◽  
Satish Ramkumar ◽  
Hiroshi Kawakami ◽  
Hong Yang ◽  
Leah Wright ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Left Atrial Strain ◽  
Incident Heart Failure ◽  
Atrial Strain

scholarly journals P1387 Correlations between left atrial strain parameters and left ventricular function in young patients presenting with acute ST elevation myocardial infarction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A I Scarlatescu ◽  
M M Micheu ◽  
M Stoian ◽  
D Zamfir ◽  
I Petre ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Young Patients ◽  
Left Ventricular ◽  
Systolic Strain ◽  
Left Atrial Strain ◽  
Peak Systolic Strain ◽  
Atrial Strain ◽  
Lv Diastolic Dysfunction

Abstract Funding Acknowledgements This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF Background Previous studies demonstrated the role of left atrial (LA) deformation parameters in characterisation of left ventricular (LV) diastolic dysfunction. It is a marker of the severity of diastolic dysfunction; LA remodelling also proved to be a predictor of clinical outcome, therefore a prognostic marker in acute coronary syndromes. Purpose In this study we aimed to investigate the correlations between left atrial strain and conventional systolic and diastolic dysfunction parameters in a cohort of young patients with acute ST elevation myocardial infarction (STEMI) treated by primary PCI. Material and methods We included 56 consecutive patients in this study: 46 patients under 50 years of age with STEMI and 10 healthy age and sex matched controls. We performed conventional transthoracic echocardiography for all included patients. In addition to conventional echocardiographic parameters, LA strain curves were obtained for each patient using two-dimensional speckle tracking imaging with measurement LA deformation parameters. Results LV ejection fraction, LV global strain and peak LA systolic strain (PALS) were significantly reduced in STEMI patients compared to controls. PALS had significant correlation with 2D LVEF (p = 0.00), LV global longitudinal strain (p = 0.03), E wave (p &lt; 0.05), E/e’ (p &lt; 0.05), left atrial volume and the type of diastolic dysfunction (p = 0.06). PALS also had inversre correlation with the presence of an occluded coronary artery at angiography. PALS was higher in control group than in STEMI group ( 34.6 vs 20.4, p &lt; 0.05). PALS values progressively decreased with worsening of LV diastolic dysfunction showing significant differences between all diastolic dysfunction grades. Using ROC (Receiver operating Characteristics) analysis we identified a cut off value of 25.9 (Sensibility 88%, Specificity 74%, AUC 0.94, CI 95%, p &lt; 0.05) to discriminate between diastolic dysfunction and normal diastolic function. Moreover, PALS was significantly different in patients with normal vs high LV filling pressures. Using ROC analysis we determined a cut off value of 14.5 for LA peak systolic strain to discriminate between the two subgroups, with excellent discrimination power, AUC 0.935, CI 95%, p = 0.045, Sensibility 100%, Specificity 91%. Therefore LA peak systolic strain could be considered a surrogate estimate of LV filling pressures. Conclusion LA peak systolic strain correlated significantly with LV systolic and diastolic function in young patients with acute myocardial infarction treated with primary PCI. Peak LA strain may be helpful as a complementary method to evaluate diastolic dysfunction in this patient population and may also improve the detection of elevated LV filling pressures.

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