scholarly journals 1231 Left atrial septal and lateral wall strains contain different pressure information: Utility in pulmonary hypertension

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F H Khan ◽  
K Inoue ◽  
O S Andersen ◽  
E Gude ◽  
H Skulstad ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Atrial ◽  
Lateral Wall ◽  
Right Atrial ◽  
Non Invasive ◽  
Information Utility ◽  
Chamber View ◽  
Right Heart Catheterisation ◽  
Pulmonary Capillary ◽  
Wedge Pressure

Abstract Funding Acknowledgements South-Eastern Norway Regional Health Authority Background Reduced left atrial (LA) reservoir strain is a marker of elevated LA pressure. Thus it could be a potential non-invasive marker to differentiate pre- and post-capillary pulmonary hypertension (PH) as the latter is defined by elevated pulmonary capillary wedge pressure (PCWP) > 15 mmHg. However, in pre-capillary PH patients with elevated right atrial pressure (RAP), the atrial septal geometry may be abnormal. This could lead to lower regional LA septal strain, making LA lateral wall strain more accurately reflect PCWP. Purpose We investigated if LA lateral wall strain can differentiate between pre- and post-capillary PH, and how LA lateral wall strain and LA septal strain are both affected by elevated RAP in pre-capillary PH. Furthermore we investigated if LA septal strain can be used in pre-capillary PH patients to identify those with elevated RAP. Methods We analysed 63 patients with PH, 28 pre-capillary and 35 post-capillary, who underwent right heart catheterisation. Echocardiography was performed simultaneously with or within 24 hours of the invasive pressure measurements. Regional LA septal strain and lateral wall strain were measured from the apical four chamber view. Results Pulmonary artery pressure was 39.5 ± 11.1 mmHg (mean ± SD) in the pre-capillary PH patients and 37.0 ± 10.1 mmHg in the post-capillary PH patients (p = ns). Mean PCWP was 9.9 ± 2.5 mmHg and 24.5 ± 6.0 mmHg (p < 0.001), respectively. LA lateral wall strain was significantly lower in patients with post-capillary PH compared to pre-capillary PH (11.9 ± 7.7% vs 26.6 ± 9.9%, p < 0.001) (Fig. a,b). At a cut-off value of 18.0%, LA lateral wall strain could predict elevated PCWP > 15 mmHg with AUC = 0.88, sensitivity = 85.7% and specificity = 76.3%. In the 28 patients with pre-capillary PH, we classified mean RAP ≥ 10 mmHg as elevated and < 10 mmHg as normal. Seven of these patients had elevated RAP and showed significantly reduced LA septal strain compared to the 21 patients with normal RAP (13.0 ± 6.2% vs 22.1 ± 7.6%, p < 0.01). LA lateral wall strain showed no difference in these groups of pre-capillary PH patients (25.8 ± 10.1% vs 28.9 ± 9.4%) (Fig. c). Conclusions LA lateral wall strain can be used for differentiating between pre- and post-capillary PH. In addition, LA septal strain may be used in pre-capillary PH patients to identify those with elevated RAP. Abstract 1231 Figure

Abstract 14798: Right Atrial Function as Prognostic factor in Patients with Pulmonary Hypertension

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yuko Fukuda ◽  
Hidekazu Tanaka ◽  
Yoshiki Motoji ◽  
Keiko Ryo ◽  
Hiroki Matsuzoe ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Heart Catheterization ◽  
Adverse Outcomes ◽  
P Wave ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Non Invasive ◽  
Chamber View ◽  
Point Set ◽  
Right Atrial Function

Background: The development of right ventricular (RV) dysfunction in patients with pulmonary hypertension (PH) has been associated with adverse outcomes. Right atrial (RA) function could be a prognostic factors as well as RV function, but non-invasive evaluation of RA function is limited. Our objective was thus to test the hypothesis that RA function was associated with hemodynamic parameters of RV performance in PH patients. Methods: Eighty PH patients with mean pulmonary artery pressure (PAP) of 40±11mmHg (all≥25mmHg) were recruited in this study. RA function was assessed by using two-dimensional speckle-tracking strain from RV-focused apical 4-chamber view. RA strain was calculated with the reference point set at the P wave, which enabled the recognition of peak negative (RAneg), positive strain (RAposi), and the sum of those values (RAtotal), corresponding to RA contractile, conduit, and reservoir function, respectively. All patients underwent right-heart catheterization for measurement of mean PAP and pulmonary vascular resistance (PVR). Results: RAneg (r=0.24 and p=0.03), RAposi (r=0.31 and p=0.01) and RAtotal (r=0.35 and p=0.001) were significantly correlated with mean PAP. In addition, RAposi (r=0.41 and p<0.001) and RAtotal (r=0.44 and p<0.001) were also correlated with PVR. Conclusions: Non-invasively assessed RA strains were associated with mean PAP and PVR. RA strain may be of a valuable additive factor for the management of PH patients, and thus have potential clinical applications.

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.

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