scholarly journals P934 Left atrial strain association with left ventricular diastolic function

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I Rodriguez Sanchez ◽  
A Anton ◽  
J J Onaindia ◽  
S Velasco ◽  
J Florido ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Function ◽  
Left Atrial ◽  
Normal Function ◽  
Left Ventricular ◽  
P Value ◽  
Peak Strain ◽  
Progressive Decrease ◽  
Significant Group ◽  
Global Peak

Abstract Objectives to evaluate the relationship between left atrial (LA) peak strain and left ventricular (LV) diastolic function and determine whether LA strain could be used to detect elevated filling pressures in a population of patients with preserved LV ejection fraction (LVpEF). Background the assessment of diastolic function is complex and multiparameter. 2016 ASE and EACVI algorithm has simplified this approach, but there are still patients with discrepant values leading to an indeterminate diagnosis, specially in patients with preserved ejection fraction. Methods we prospectively included 129 patients in our cohort. Inclusion criteria were LVEF > 50% and sinus rhythm. Patients with atrial fibrillation, significant mitral valvulopathy or poor quality imaging were excluded. Two-dimensional speckle tracking was used to measure peak LA strain in all LA segments (using apical 4 chamber, 2 chamber and 3 chamber views). We evaluated the association of LA global peak strain and LA 4 chamber peak strain with the different categories of diastolic function according to the 2016 ASE and EACVI algorithm. Results Both LA global peak strain and 4 chamber LA peak strain showed a progressive decrease with worsening diastolic dysfunction (DD) severity (Table 1). A global LA peak strain cutoff value of 28,35% was very accurate to differentiate normal from elevated filling pressures (normal function or grade 1 DD from grades 2 and 3 DD). Diagnostic accuracy: 80.20%; area under the curve: 0,80 (0,72-0,88); A significant group of patients (21,1%) could not be categorized using 2016 algorithm. Conclusions Both LA global peak strain and 4 chamber LA peak strain demonstrated a progressive decrease with worsening DD severity. Global LA peak strain value of 28,35% was an accurate cutoff to differenciate patients with normal vs elevated filling pressures. LA strain values and diastolic function Total LA global peak STRAIN LA 4C STRAIN N (%) p-value p-value Total 129 30.90 %(11.77) 30.43 (12.36) Diastole <0.0001 <0.0001 Normal function 36 (28.13) 39.72% (9.59) 39.98 (10.59) Indeterminate Diastolic Function 23 (17.97) 31.07% (7.97) 30.19 (7.50) Indeterminate DD 4 (3.13) 30.68 % (6.72) 29.75 (7.31) grade 1 DD 22 (17.19) 32.69 % (12.54) 32.98 (14.46) grade 2 DD 36 (28.13) 23.90 % (9.32) 23.53 (9.49) grade 3 DD 7 (5.47) 15.43 % (5.72) 15.85 (7.32)

P1027Left atrial hypertension invasively measured during pulmonary vein isolation as a predictor of atrial fibrillation recurrence

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Manfrin ◽  
G Mugnai ◽  
G B Chierchia ◽  
C Bilato ◽  
W G Rauhe
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Ejection Fraction ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Drug Resistant ◽  
Ventricular Ejection Fraction

Abstract Background The clinical role of left atrial hypertension (LAH) in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. Purpose The aim of the present study was to analyse the prevalence of LAH in patients with nonvalvular AF and preserved left ventricular ejection fraction having undergone PV isolation and its implication for AF catheter ablation. Methods Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were retrospectively included in this analysis. Left atrial hypertension was defined as the LA mean pressure >15 mm Hg. Results A total of 98 consecutive patients (71 males, 72%; mean age 60.3 ± 8.4 years) with drug resistant, non valvular AF and preserved LV ejection fraction having undergone index PV isolation procedure were included in the analysis. Eleven patients (11%) underwent radiofrequency ablation and 87 (89%) cryoballoon ablation. The mean LA pressure was 10.7 ± 4.5 mmHg; LAH occurred in 24 (24%) patients. At a mean follow up of 14.6 ± 7.1 months (median 14 months), the success rate without antiarrhythmic therapy was 71.4% (70/98; considering the blanking period). On multivariate analysis, LAH remained the only independent predictor of definitive AF recurrence (HR 3.02, 1.36-6.72, p = 0.007). Conclusion Left atrial hypertension was found in 24% of patients undergoing PV isolation and was found to be significantly related to both early and late AF recurrences. Univariate and multivariate Cox regressi Univariate analysis Multivariate analysis Early Recurrence (during BP) HR 95%CI P value HR 95%CI P value Age (years) 1.06 1.02-1.10 0.005 1.05 1.00-1.09 0.03 LA volume (ml/m2) 1.02 1.00-1.05 0.04 1.02 1.00-1.05 0.05 LA hypertension 2.46 1.32-4.57 0.004 1.97 1.03-3.79 0.04 Recurrence after the BP HR 95%CI P value HR 95%CI P value Age (years) 1.05 1.00-1.11 0.04 1.04 0.98-1.09 0.15 LA hypertension 3.51 1.62-7.60 0.001 3.02 1.36-6.72 0.007 BP recurrence 1.83 0.84-3.99 0.13 AF atrial fibrillation. BMI: body mass index. LA: left atrium. CAD: coronary artery disease. BP: blanking period. HR: hazard ratio. CI: confidence intervals.

P2470The prognostic importance and inter-relationship of systolic and diastolic tissue Doppler velocities in heart failure patients with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Sengelov ◽  
P G Jorgensen ◽  
N E Bruun ◽  
T Fritz-Hansen ◽  
F J Olsen ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Function ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Systolic And Diastolic Function ◽  
Relationship Of

Abstract Background Tissue Doppler imaging (TDI) can be used to evaluate both the systolic and diastolic function in patients with heart failure with reduced ejection fraction (HFrEF). However, previous studies have shown important inter-relationship between these measures in other patient populations. Purpose To investigate the prognostic importance and inter-relationship of systolic and diastolic TDI measures in HFrEF. Methods Conventional echocardiographic measurements together with peak longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities from all 6 myocardial walls were obtained from 1065 HFrEF patients. Outcome was all-cause mortality. Results Mean age was 67 years, 74% were male and mean left ventricular ejection fraction was 27%. During a median follow-up period of 40 months, 177 (16.6%) patients died. In univariable analyses, both s' and a' were associated with mortality (p<0.001), but e' was not (p>0.05). Patients were therefore stratified into high/low groups by the mean value of s' and a' respectively. The prognostic value of s' was significantly modified by a' (p for interaction 0.035). In patients with low s', low a' was associated with an increased risk of dying; HR 1.31 (CI: 1.17–1.55, P=0.001) per 1 cm/s decrease. Patients with both impaired systolic and diastolic function as assessed by low s' and a' had over 3 times greater risk of dying compared to having both high measures of s' and a' (HR 3.39, CI: 2.1–5.1, p<0.001) (figure). Having combined impaired systolic and diastolic function as assessed by low s' and a' remained an independent predictor of mortality even after multivariable adjustment for age, gender, body mass index, mean arterial pressure, ischemic cardiomyopathy, pacemaker, heart rate, total cholesterol, diabetes and conventional echocardiographic measures (HR 1.78 (CI: 1.04–3.04, p=0.035) (table)). Uni- and multivariable Cox regressions Variable Univariable model (95% CI) Multivariable model* HR (95% CI) P value HR (95% CI) P value High s' and high a' (n=386) Ref Ref High s' and low a' (n=113) 1.48 (1.07–4.03) 0.24 1.36 (0.69–2.70) 0.37 Low s' and high a' (n=156) 2.26 (1.34–3.81) 0.002 1.55 (0.86–2.78) 0.14 Low s' and low a' (n=262) 3.29 (2.43–5.75) <0.001 1.78 (1.04–3.04) 0.035 *Multivariable model adjusted for age, gender, body mass index, mean arterial pressure, ischemic cardiomyopathy, pacemaker, heart rate, total cholesterol, diabetes, left ventricular ejection fraction, left ventricular mass index, and deceleration time. Kaplan-Meier curves depicting survival Conclusion A pattern of combined low systolic and diastolic performance as assessed by s' and a' is a significant marker of adverse prognosis for patients with HFrEF, independent of conventional echocardiographic parameters. Acknowledgement/Funding None

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 Left Atrial Longitudinal Strain Evaluated by 2D Speckle Tracking Echocardiography Can Identify Patients with Heart Failure with Preserved Ejection Fraction

2019 ◽  
Vol 16 (1) ◽  
pp. 7-19
Author(s):  
Mihaela Bolog ◽  
Mihaela Dumitrescu ◽  
Mârzan Luminiţa ◽  
Florentina Romanoschi ◽  
Elena Păcuraru ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Signs And Symptoms ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Preserved Ejection Fraction

AbstractThe aim of the paper is to investigate the utility of left atrial longitudinal strain (LALS) in the diagnosis of heart failure with preserved ejection fraction (HFpEF) when left ventricular diastolic function is indeterminable and the assessment of natriuretic peptides is not routinely performed.Method. The study included 180 patients with signs and symptoms suggestive of non-acute heart failure, examined clinically and echocardiographically, both conventionally and via speckle tracking method.Results. 33 patients had a normal echocardiographic examination. Diastolic dysfunction (DD) was present in 116 patients of whom 32 patients had grade I, 66 patients grade II, 18 patients grade III DD. Diastolic function could not be determined in 31 patients. The mean value of LALS and NTproBNP in patients with normal echocardiography was significantly different from the group with DD for both variables (p<0.001). LALS was inversely correlated with the grade of DD (r=-0.83, p<0.001). The cut-off value of LALS for predicting DD was 25%. Applying this value in patients with indeterminate diastolic function we identified 21 patients with HFpEF (p<0.001).Conclusions. LALS can help in the diagnosis of HFpEF when other echocardiographic criteria are irrelevant and NTproBNP is not routinely performed. LALS was correlated with the presence and severity ofDDwith a cut-off value of 25%.

scholarly journals Linking diastolic function to cardiac exercise performance in heart failure with preserved ejection fraction: a virtual patient study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Van Loon ◽  
C Knackstedt ◽  
R Cornelussen ◽  
KD Reesink ◽  
HP Brunner-La-Rocca ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Exercise Performance ◽  
Left Atrial ◽  
Relaxation Function ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Passive Stiffness ◽  
Wide Range

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NWO-ZonMw Background The relative impact of left ventricular (LV) diastolic dysfunction (LVDD) and impaired left atrial (LA) function on cardiac exercise performance (CEP) in heart failure with preserved ejection fraction (HFpEF) remains largely unknown Purpose To elucidate the relative effects of LVDD and impaired LA function on hemodynamics at rest and on cardiac performance during exercise by performing virtual HFpEF patient simulations. Methods Using a well-validated cardiovascular system model (CircAdapt), impaired LV relaxation was simulated by increasing the rate of myocardial relaxation (tau) from 35 to 65 ms. To study the effect of moderate and sever LV myocardial stiffness increase, LV end-diastolic elastance was increased from 0.15 mmHg/ml to 0.60 mmHg/ml and 2.00 mmHg/ml, respectively. In each simulation, LV diastolic function at rest (cardiac output (CO) and heart rate (HR) of 5.1 l/min and 70 bpm, respectively) was assessed using LV ejection fraction (LVEF), mitral E/A ratio, maximum LA volume (LAV), and mean left atrial (LA) pressure (mLAP). To investigate the relative effect of these cardiac abnormalities on exercise capacity, CO and HR were gradually increased using a fixed CO-HR relationship until mLAP exceeded a threshold pressure of 35 mmHg, which was assumed to be a physiological limit of exercise intensity. Results Simulations showed that regardless of the modelled LV and LA function, LVEF was preserved (&gt;50%). Impaired LV relaxation function was associated with decreased E/A-ratio and a small increase in mLAP at rest, regardless of LA function. Increased LV passive stiffness resulted in increased E/A-ratio, LA dilation and markedly elevated mLAP at rest, regardless of LA function (Figure: top-left). Impaired LA function resulted in reduced A-peak velocity, and increased E/A–ratio, LAV and mLAP at rest regardless of LV function (Figure: top-right) Exercise simulations showed that increased LV passive stiffness exerts a stronger exercise-limiting effect than impaired LV relaxation function, in particular when LA function is impaired (Figure: bottom). Conclusions Through simple and well-controlled variations in LV and LA function, we were able to simulate virtual HFpEF patients with a wide range of LVDD severities at rest, preserved LVEF, and reduced cardiac exercise performance. In general, our simulations suggest that increased LV passive stiffness, rather than impaired LV relaxation function, reduces exercise tolerance, especially in the presence of LA dysfunction. Abstract Figure. Simulating rest & exercise hemodynamics

P2457Left atrial strain parameters predict clinical outcomes in patients with HFmrEF and HFpEF

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Vrettos ◽  
L Al Saikhan ◽  
L Matiti ◽  
C Plymen ◽  
B Low ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Function ◽  
Left Atrial ◽  
Left Ventricular ◽  
Baseline Characteristic ◽  
Operating Characteristics ◽  
Increased Risk ◽  
Echocardiographic Parameters ◽  
Systolic And Diastolic Function

Abstract Background Heart failure with preserved ejection fraction (HFpEF) and with mid-range ejection fraction (HFmrEF) are conditions sharing similar diagnostic criteria and symptoms. Left ventricular (LV) diastolic dysfunction has often been considered central to the pathophysiology of both, as determined by current conventional echocardiographic measures of elevated filling pressure and/or an increased in left atrial (LA) volume. However, the independent prognostic importance of LA function, beyond clinical predictors and LV features, in those groups remains unclear. Aims To evaluate the prognostic value of LA function measured by speckle tracking echocardiography in patients with new diagnosis of HFpEF and HFmrEF. Methods A total of 171 consecutive patients diagnosed with HFpEF with an Ejection Fraction (EF) ≥50%, or HFmrEF with an EF of 40–49% were prospectively enrolled and followed up. Follow-up was completed in 134 patients with HFpEF (n=100) and HFmrEF (n=34) for a median period of 57 months. Baseline characteristic and comorbidities were recorded, as well as conventional resting echocardiographic parameters of systolic and diastolic function. Left atrial phasic function was analysed using 2D-Specle Tracking. Peak-atrial longitudinal strain (PALS) and peak-atrial contraction strain (PACS) were measured, reflecting LA reservoir and pump function respectively. We looked at the relationship of traditional parameters of systolic and diastolic function and LA strain, with the following cardiovascular (CV) events: acute coronary syndromes, new atrial fibrillation, cerebrovascular events, HF-related admissions and cardiac deaths. Results During a median follow up period of 57 months (range 11.10), of 134 patients, 42 (31%) had at least one CV event, 10 (8%) out of whom had at least one HF-related hospitalization and 5 (4%) had cardiac death. 92 patients (69%) remained event-free. In univariate analysis, lower PALS and PACS were associated with increased risk for the composite endpoint of all CV-events (PALS OR=0.92 p<0.01 and PACS OR=0.92 p<0.05), but only PALS predicted HF admissions (PALS OR=0.86 p<0.05). In multivariate analysis after adjusting for LV EF, E/e' and LAVi, PALS remained significant at predicting CV-events (OR=0.91 p<0.05) and HF admissions (OR=0.85 p<0.05), but PACS did not. Amongst all echocardiographic parameters measured, PALS had the greatest Area Under the Curve at Receiver Operating Characteristics analysis (AUC=0.78 p<0.05) and a PALS value of <23% best predicted future HF-related admissions (sensitivity 0.9, specificity 0.6). Conclusion LA dysfunction in HFpEF and HFmrEF is associated with a higher risk of CV events and HF hospitalizations. The association of LA strain with HF hospitalization remained significant after adjustment for systolic and diastolic parameters.

scholarly journals Arrest of atherosclerosis progression after interruption of GH replacement in adults with congenital isolated GH deficiency

2012 ◽  
Vol 166 (6) ◽  
pp. 977-982 ◽  
Author(s):  
Vanessa P Araujo ◽  
Manuel H Aguiar-Oliveira ◽  
Joselina L M Oliveira ◽  
Hertaline M N Rocha ◽  
Carla R P Oliveira ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Function ◽  
Gh Deficiency ◽  
Systolic Function ◽  
Receptor Gene ◽  
Intima Media Thickness ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Carotid Imt ◽  
Gh Replacement

ObjectiveGH replacement therapy (GHRT) in adult-onset GH deficiency (AOGHD) reduces carotid intima-media thickness (IMT) and increases myocardial mass, with improvement of systolic and diastolic function. These observations have reinforced the use of GHRT on AOGHD. Conversely, we have previously reported that in adults with lifetime congenital and severe isolated GH deficiency (IGHD) due to a mutation in GHRH receptor gene (GHRHR), a 6-month treatment with depot GH increased carotid IMT, caused the development of atherosclerotic plaques, and an increase in left ventricular mass index (LVMI), posterior wall, and septal thickness and ejection fraction. Such effects persisted 12 months after treatment (12-month washout – 12mo).MethodsWe have studied the cardiovascular status (by echocardiography and carotid ultrasonography) of these subjects 60 months after completion of therapy (60-month washout – 60mo).ResultsCarotid IMT reduced significantly from 12 to 60mo, returning to baseline (pre-therapy) value. The number of individuals with plaques was similar at 12 and 60mo, remaining higher than pre-therapy. LVMI, relative posterior wall thickness, and septum thickness did not change between 12 and 60mo, but absolute posterior wall increased from 12 to 60mo. Systolic function, evaluated by ejection fraction and shortening fraction, was reduced at 60mo in comparison with 12mo returning to baseline levels. The E/A wave ratio (expression of diastolic function) decreased at 60mo compared with both 12mo and baseline.ConclusionsIn adults with lifetime congenital IGHD, the increase in carotid IMT elicited by GHRT was transitory and returned to baseline 5 years after therapy discontinuation. Despite this, the number of subjects with plaques remained stable at 60mo and higher than at baseline.

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