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 < 0.05), E/e’ (p < 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 < 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 < 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.

scholarly journals Left Atrial Strain to Identify Diastolic Dysfunction in Children with Cardiomyopathies

2019 ◽  
Vol 8 (8) ◽  
pp. 1243 ◽  
Author(s):  
Jolanda Sabatino ◽  
Giovanni Di Salvo ◽  
Costantina Prota ◽  
Valentina Bucciarelli ◽  
Manjit Josen ◽  
...  
Keyword(s):  
Strain Rate ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Systolic Strain ◽  
Operating Characteristics ◽  
Left Atrial Strain ◽  
Peak Systolic Strain ◽  
Strain And Strain Rate ◽  
Significant Difference

Background: Left ventricular (LV) diastolic dysfunction (DD) carries worse prognosis in childhood. 2-dimensional (2-D) left atrial (LA) strain accurately categorizes DD in adults but its role in children is unknown. Thus, the aim of this study is to investigate whether LA strain and strain rate could diagnose and classify DD in children with dilated (CMD), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies (CM). Methods and Results: The study includes 136 children (aged 8.8 ± 6 years): 44 with DCM, 40 with HCM, 7 with RCM and 45 healthy controls (CTRL). They underwent standard echocardiographic examination and 2-D speckle-tracking analyses (LV longitudinal peak systolic strain (LS), LA peak systolic strain and strain rate). No significant differences in mitral E/A and pulmonary S/D ratios were observed among the four groups. Although E/E’ and indexed left atrial volumes were found to be significantly higher in HCM, DCM and RCM compared to CTRL (p < 0.001), they showed no significant difference among the three CM groups. LV LS values were significantly reduced in CM vs CTRL (p < 0.001) and in DCM vs HCM (p < 0.01), with no other differences between the remaining groups. LA peak systolic strain and strain rate values showed a steady and significant decrease with worsening of DD. Receiver Operating Characteristics (ROC) curves showed area under the curve of 0.976 (p < 0.001) for LA strain and 0.946 (p < 0.001) for LA strain rate, to distinguish CTRL from CMs. Conclusions: LA strain and strain rate could be a promising tool to better understand and classify DD in children with cardiomyopathies, opening the way to its clinical use.

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

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 &lt;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

scholarly journals 773 Correlation between high troponin levels and left atrial strain as biomarker of incremented atrial fibrillation rate in patients with acute myocardial infarction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Emilia De Luca ◽  
Andrea Madeo ◽  
Giovanni San Pasquale ◽  
Gianluca Ponturo ◽  
Francescantonio Rosselli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Atrial Strain ◽  
Ventricular Ejection Fraction ◽  
Heart Rhythm Disorders ◽  
Atrial Strain

Abstract Aims Heart rhythm disorders, both bradyarrhythmias and tachyarrhythmias, are the most frequently observed complication in the acute phase and after primary angioplasty in patients with acute myocardial infarction (AMI). New onset atrial fibrillation (Afib) represents the most frequent arrhythmia found between 6% and 21% in patients with AMI and its onset increases the thromboembolic and mortality risk of all causes of those patients. Troponin levels measured with modern assays represent today the most specific cardiac biomarker of myocardial injury and its measurement represents the cornerstone for the diagnosis of AMI in accordance with the ESC Guidelines 2018; however, also Afib itself causes an increase in troponin values (troponinopathy). Therefore, the single biohumoral value cannot assume prognostic value in helping the clinician to recognize patients with AMI who are more predisposed to encounter Afib. So, the object of our evaluation was to support the elevated troponin values with echocardiographic biomarkers, such as the evaluation of the left atrial strain (LAS), to perform a more accurate stratification of the arrhythmic risk in patients with AMI. Methods and results A prospective multiparametric study was carried out at our Interventional Cardiology Hub Center. 240 patients with ACS-STEMI diagnosed were recruited over one year from March 2020 to March 2021. Patients included were all ≥18 (55 ± 23 y), predominantly male (88% male, 12% female). Exclusion criteria were: permanent atrial fibrillation; valvular heart disease (moderate or severe heart valve stenosis or valve replacement); implantation of a pacemaker or defibrillator; (4) poor image quality. Emergency coronary angiography (CAG) was carried out to execute primary percutaneous intervention (primary PCI with DES) on the culprit vessel. All patients underwent echocardiography by GE Vivid 80 (GE Ultrasound, Horten, Norway) in order to evaluate changes in segmental kinetics, left ventricular ejection fraction (LVEF). The ratio of peak early filling velocity of mitral inflow to early diastolic annulus velocity (E′) of the medial annulus (E/E′) was calculated. Left atrial volumes (LAVi, ml/m2) and diameter were obtained through standard apical 4 and 2 chamber views with a frame-rate range of 40–71 frames/s; then, offline analysis of images was performed using EchoPAC version 201 (GE Vingmed Ultrasound) (VSSLV) software in order to calculate LAS for each one. Patients were subjected to serial sampling to evaluate temporally troponin values and the possible Afib appearance was recognized by telemetry monitoring. Statistical analysis was performed using SPSS version 20 (IBM, Armonk, New York), continuous variables were expressed as mean ± standard deviation (SD). Pearson’s correlation coefficient was used to assess the correlation between strain value, baseline characteristics and troponin levels. All statistical tests are two-sided, and a P-value &lt; 0.05 is considered statistically significant. Two groups were recognized: high troponin levels with pathological LAS and new Afib (N = 47); medium-high troponin levels with normal LAS and no Afib (N = 143). Respectively, LAS were 8.4 ± 4.0% vs. 16 ± 4.5%, P &lt; 0.001, LAVi 44 ± 5 ml/m2 vs. 30 ± 3.2, P = 0.001, and peak of troponin levels (3.45 ± 0.46 ng/ml vs. 2.34 ± 0.22 ng/ml, P = 0.002). Multivariate analysis identified that peak troponin levels alone wasn’t a prognostic index of increased arrhythmic burden, while the correlation between high peak levels and altered LAS were independent predictors of new AFib in AMI. Conclusions The evaluation of atrial dysfunction by new echo-derived parameters and its correlation with troponin values allows a more accurate stratification of arrhythmic risk in patients with ACS. The applicability of the obtained data would allow a more careful evaluation of the clinical trend and the prognostic outcome in the subcategory analysed. Therefore, the association between biohumoral and instrumental parameters could become new biomarkers capable of predicting an increase in thromboembolic risk in AMI patients. The creation of an app that takes into account the parameters listed could be a possible future support that can help the clinician calculate the increased risk rate of new Afib in patients with ACS.

scholarly journals Left atrial strain in patients with arterial hypertension

2015 ◽  
Vol 1 (1) ◽  
pp. 31 ◽  
Author(s):  
Mateli Cameli
Keyword(s):  
Arterial Hypertension ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Normal Range ◽  
Left Atrial Strain ◽  
Patient Groups ◽  
And Gender ◽  
Atrial Strain

<p><span>Background: </span>Arterial hypertension (HTN) causes left ventricular (LV) cavity dysfunction even if ejection function (EF) remains preserved. Recent studies have shown that diastolic dysfunction and left atrial (LA) dilatation are also associated with myocardial dysfunction. The aim of the present study was to explore the nature of LA longitudinal function disturbances in hypertensive patients with normal LV and LA structure and conventional function parameters.</p><p><span>Methods: </span>Peak atrial longitudinal strain (PALS) was evaluated in 78 patients with systemic HTN and preserved EF (≥ 55%) divided in 41 patients with diastolic dysfunction but no hypertrophy (group HTNdd), and 37 patients with no diastolic dysfunction or hypertrophy (group eHTN). Results were compared with those from 38 age and gender-matched healthy controls.</p><p><span>Results: </span>Indexed LA area and indexed LA volume were within the normal range and not different between the two patient groups and controls. eHTN group had reduced global PALS (p &lt; 0.001) and four-and two-chamber average PALS (p &lt; 0.001 for both). Similar abnormalities were seen in HTNdd group but to a worse degree (P &lt; 0.01 for both). LV EF was not different between the eHTN and HTNdd groups compared to controls. LV E/e’ ratio was the strongest predictor of reduced global PALS in both eHTN and HTNdd groups.</p><p><span>Conclusion: </span>Asymptomatic untreated HTN patients with preserved LVEF and normal diastolic function have compromised LA strain despite normal cavity size, consistent with preclinical LA myocardial dysfunction.</p>

scholarly journals Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jonas Jenner ◽  
Ali Ilami ◽  
Johan Petrini ◽  
Per Eriksson ◽  
Anders Franco-Cereceda ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Diastolic Dysfunction ◽  
Valve Replacement ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Atrial Strain ◽  
Structural Recovery ◽  
Atrial Strain

Abstract Background The impact of volume overload due to aortic regurgitation (AR) on systolic and diastolic left ventricular (LV) indices and left atrial remodeling is unclear. We assessed the structural and functional effects of severe AR on LV and left atrium before and after aortic valve replacement. Methods Patients with severe AR scheduled for aortic valve replacement (n = 65) underwent two- and three-dimensional echocardiography, including left atrial strain imaging, before and 1 year after surgery. A control group was selected, and comprised patients undergoing surgery for thoracic aortic aneurysm without aortic valve replacement (n = 20). Logistic regression analysis was used to assess predictors of impaired left ventricular functional and structural recovery, defined as a composite variable of diastolic dysfunction grade ≥ 2, EF < 50%, or left ventricular end-diastolic volume index above the gender-specific normal range. Results Diastolic dysfunction was present in 32% of patients with AR at baseline. Diastolic LV function indices and left atrial strain improved, and both left atrial and LV volumes decreased in the AR group following aortic valve replacement. Preoperative left atrial strain during the conduit phase added to left ventricular end-systolic volume index for the prediction of impaired LV functional and structural recovery after aortic valve replacement (model p < 0.001, accuracy 70%; addition of left atrial strain during the conduit phase to end-systolic volume index p = 0.006). Conclusions One-third of patients with severe AR had signs of diastolic dysfunction. Aortic valve surgery reduced LV and left atrial volumes and improved diastolic indices. Left atrial strain during the conduit phase added to the well-established left ventricular end-diastolic dimension for the prediction of impaired left ventricular functional and structural recovery at follow-up. However, long-term follow-up studies with hard endpoints are needed to assess the value of left atrial strain as predictor of myocardial recovery in aortic regurgitation.

P4372Left atrial strain: a potential marker of early diastolic dysfunction in patients with Marfan syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Garcia-Izquierdo Jaen ◽  
S Mingo Santos ◽  
M Torres Sanabria ◽  
V Monivas Palomero ◽  
S Moreno Casado ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ejection Fraction ◽  
Strain Rate ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Healthy Controls ◽  
Left Atrial Strain ◽  
Strain And Strain Rate ◽  
Atrial Strain

Abstract Background/Introduction Previous studies using conventional echocardiographic measurements have reported subclinical left diastolic dysfunction in patients with Marfan syndrome (MFS). Left atrial strain (LAS) has been shown to be an accurate predictor of left ventricular diastolic dysfunction. However, there is no evidence regarding the use of LAS in MFS. Purpose To assess feasibility of LAS and compare LAS derived measurements along with traditional diastolic parameters in MFS patients vs healthy controls. Methods 46 MFS patients (normal LV ejection fraction, no previous cardiovascular surgery, no significant valvular regurgitation) vs. 20 healthy controls (age and sex-matched). We performed LAS analysis using 2D speckle-tracking (QLAB 10, Philips). LA strain was determined as the average value of the longitudinal deformation (7 segments) in the apical 4-chamber view (RR gating). Results LAS analysis was feasible in 40 MFS patients (87%). All participants had normal diastolic function according to current guidelines (ASE/EACVI 2016). MFS patients showed lower TDI e' velocities and higher average E/e' ratio, but still within normal range. Similarly, LVEF was normal but slightly reduced in MFS patients. LA strain and strain rate parameters during reservoir and conduit phase were significantly impaired in MFS patients compared to controls. MFS vs controls MFS patients (n=40) Controls (n=20) p MFS patients (n=40) Controls (n=20) p Age 33.8±12.4 34.4±8.3 0.846 Septal e' (cm/s) 9.7±2.5 11.7±2.3 0.006 Male (%) 24 (60%) 12 (60%) 1.000 Average E/e' ratio 6.8±1.5 5.5±1.1 0.002 SBP (mmHg) 120.3±12.4 120.1±9.4 0.969 TR velocity (cm/s) 208.6±21.4 201.6±22.9 0.390 DBP (mmHg) 72.0±10.1 67.1±6.2 0.069 LAVi (ml/m2) 23.5±7.1 25.5±4.8 0.260 Aortic root (mm) 40.3±4.6 31.7±3.7 <0.001 LASr (%) 32.6±8.8 43.0±8.3 <0.001 LVEF (%) 60.9±5.6 64.2±4.2 0.022 LAScd (%) −20.1±8.0 −29.4±5.5 <0.001 E-wave (cm/s) 74.6±16.5 76.7±16.5 0.651 LASct (%) −12.8±6.1 −13.6±5.2 0.622 A-wave (cm/s) 55.2±10.9 52.0±12.8 0.327 LASRr 2.02±0.49 2.31±0.43 0.030 E/A ratio 1.4±0.4 1.5±0.4 0.287 LASRcd −2.22±0.61 −3.07±0.68 <0.001 Lateral e' (cm/s) 13.0±3.6 16.3±3.3 0.002 LASRct −2.24±0.90 −2.35±0.75 0.600 SBP: Systolic blood pressure. DBP: Diastolic blood pressure. LVEF: Left ventricular ejection fraction. LAVi: Left atrial volume index. LAS: Left atrial strain. LASR: Left atrial strain rate. (r): Reservoir. (cd): Conduit. (ct): Contraction. Example of LA strain and strain rate Conclusion MFS patients showed a subtle impairment in diastolic function compared to controls. Although further evidence is needed, LAS derived parameters could be early markers of diastolic dysfunction in this group of patients. Acknowledgement/Funding Programa de Actividades de I+D de la Comunidad de Madrid

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