P1484Exploring the grey zone of E/e' ratio: does left atrial strain help?

Abstract Background The combination of early trans-mitral inflow and mitral annular tissue Doppler velocities (E/e' ratio) is widely applied to noninvasively estimate left ventricular (LV) filling pressures. However E/e' ratio has a significant gray zone that restrict its accuracy and left atrial (LA) deformation analysis by speckle tracking echocardiography (STE) was recently proposed as an alternative approach to estimate LV filling pressures, but the clinical application of LA strain in the subgroup of patients with E/E' between 8 and 14 has been under-investigated. Aims This study aimed to analyze the role of LA longitudinal function by STE (PALS) to estimate intra-cardiac pressures as assessed by systolic pulmonary artery pressure (sPAP), measured by Doppler, specifically in patients with an E/e' ratio >8 and ≤14. Methods We enrolled 142 consecutive, non-selected patients, referred to our echocardiography laboratory for a comprehensive transthoracic echocardiography. Exclusion criteria were: organic mitral valve disease or prosthesis and presence of disease possibly associated with pre-capillary pulmonary hypertension. Particular care was used for accurate measurement of maximal tricuspid regurgitation velocity and of right atrial pressure and consequently sPAP estimation. PALS values were obtained by averaging all segments, and by separately averaging segments measured in the 4-chamber and 2-chamber views. Results Seventy-four patients (52% of total) showed an E/e' ratio >8 and ≤14, with the following characteristics: mean age 65.5±11.9 years, LVEF 54.5±11.2, E/e' 11.2±1.9, sPAP 33±7 mmHg, PALS 31.6±11.7%. A negative correlation between PALS and sPAP was found (r=−0.55, p<0.0001). From receiver operating characteristic (ROC) curves, PALS demonstrated a high diagnostic accuracy (AUC 0.78 (95% CI: 66%–90%)); the cutoff value of 23% showed an excellent specificity of 90% with a sensibility of 60%, to predict sPAP higher than 35 mmHg. Correlation between sPAP and PALS Conclusions LA function measured by STE is a simple parameter able to predict increased intra-cardiac pressure even in the intermediate E/E' group. This parameters might help in improving the diagnostic algorithm of diastolic function.

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How to incorporate left atrial strain in the diagnostic algorithm of left ventricular diastolic dysfunction

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-020-02070-6 ◽

2020 ◽

Author(s):

L. F. Cerrito ◽

C. Maffeis ◽

R. M. Inciardi ◽

E. Tafciu ◽

G. Benfari ◽

...

Keyword(s):

Diastolic Dysfunction ◽

Left Atrial ◽

Diagnostic Algorithm ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Left Atrial Strain ◽

Ventricular Diastolic Dysfunction ◽

Atrial Strain

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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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Abstract 16537: Left Atrial Strain in Evaluation of Heart Failure With Preserved Ejection Fraction

Circulation ◽

10.1161/circ.142.suppl_3.16537 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Zi Ye ◽

William Miranda ◽

Darwin F Yeung ◽

Garvan Kane ◽

Jae K Oh

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Left Atrial ◽

Area Under The Curve ◽

Diagnostic Algorithm ◽

Left Ventricular ◽

Exercise Stress ◽

Preserved Ejection Fraction ◽

Left Atrial Strain ◽

Atrial Strain

Introduction: Patients with heart failure with preserved ejection fraction (HFpEF) may have elevated left ventricular filling pressure with exercise (LVFP-ex), despite normal LVFP at rest. We aimed to assess the diagnostic value of resting left atrial strain (LAS) in detecting elevated LVFP-ex in dyspneic patients evaluated by exercise stress echocardiography. Methods: We performed 2D-speckle tracking analysis for LAS in 669 consecutive patients (mean age 64 ± 14, men 53%) who underwent treadmill echocardiography evaluation and had LV ejection fraction ≥50%. Assessment of LVFP at rest was based on the 2016 ASE Guidelines for diastolic function assessment. We used the 2019 ESC HFA-PEEF diagnostic algorithm to define elevated LVFP-ex (early mitral inflow wave/septal early diastolic tissue velocity (E/e’) ≥ 15 after exercise) and calculate a continuous HFA-PEEF score. Results: LAS reservoir was lowest in patients with elevated LVFP at rest (n=81) and lower in those with normal resting FP who developed elevated LVFP-ex (n=108) compared to those who maintained normal LVFP-ex (29.0 ± 5.2% vs. 33.1 ± 5.0% vs.39.3 ± 4.8%, p < 0.001). In patients with normal or indeterminate LVFP at rest (n=587), LAS reservoir and pre-exercise HFA-PEEF score demonstrated an area-under-the-curve (AUC) of 0.82 and 0.7 respectively for elevated LVFP-ex. There was a 28% higher odds of developing elevated LVFP-ex per 1% decrease in LAS reservoir (odds ratio, 95%CI: 0.78, 0.74 - 0.82). In patients with the intermediate score (n=461), 123 patients developed elevation in LVFP with exercise and were classified as having HFpEF per the diagnostic algorithm. Addition of LAS reservoir improved the predictive value of HFA-PEEF score for HFpEF (AUC increased from 0.71 to 0.80, p for ΔAUC =0.01). Conclusions: LAS reservoir has a potential to identify patients at intermediate-risk for HFpEF who may develop elevated LVFP with exercise only, and therefore a promising parameter to aid in the diagnosis of HFpEF when exercise testing is not feasible.

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Left ventricular strain and left atrial strain are impaired during hemodialysis in children

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02350-9 ◽

2021 ◽

Author(s):

Tam T. Doan ◽

Poyyapakkam Srivaths ◽

Asela Liu ◽

J. Kevin Wilkes ◽

Alexandra Idrovo ◽

...

Keyword(s):

Left Atrial ◽

Left Ventricular ◽

Left Atrial Strain ◽

Left Ventricular Strain ◽

Atrial Strain

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The effects of doxorubicin on left and right atrial mechanics in patients with lymphoma

European Heart Journal ◽

10.1093/ehjci/ehaa946.3284 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Vahabi ◽

E Kharati-Koopaei ◽

M Stewart ◽

H Hancock ◽

M Norouzi ◽

...

Keyword(s):

Strain Rate ◽

Left Atrial ◽

Left Ventricular ◽

Right Atrial ◽

Lv Function ◽

Compensatory Mechanism ◽

Research Association ◽

Anthracycline Cardiotoxicity ◽

Diastolic Strain Rate ◽

Significant Change

Abstract Background Despite the associated dose-dependent cardiotoxicity, anthracyclines continue to form the backbone of modern chemotherapy regimens. Speckle Tracking Echocardiography (STE) has been a popular method of quantifying cardiac function but most studies have focused on left ventricular function. Research into the effects of anthracyclines on left atrial (LA) and right atrial (RA) function continues to be neglected. Purpose To investigate the effects of doxorubicin, a commonly used anthracycline, on both the LA and RA systolic and diastolic strain and strain-rate parameters in two groups of patients with lymphoma: Group 1 (G1) with a conventional drop in ejection fraction (EF <53%), and Group 2 (G2) without. Methods We retrospectively studied 46 patients treated for lymphoma between 2015 and 2018; G1 (n=12) and G2 (n=34). Echocardiograms performed at baseline (T0), mid-chemotherapy (T1), and post-chemotherapy (T2), were analysed by using offline vendor-independent software (TomTec, 2D Cardiac Performance Analysis). Using 2D STE, LA and RA reservoir, conduit and contractile strains, systolic and diastolic strain-rates were measured. Multi-level longitudinal model was used for statistical analysis.This study was ethically approved by the Health Research Association (REC Reference 18/SS/0139). Results Median age was 64 years (IQR 51–74 years) in G1, and 65 years (IQR 57–73 years) in G2. In G1, there was no significant change in LA reservoir strain with time, however a significant decline with an average mean difference of −7.52 was seen between T0 to T2 (p=0.016) in G2. LA conduit strain did not significantly change in either group with incremental doses of doxorubicin. However, LA contraction strain was seen to significantly increase in G1 between T1 to T2 (p=0.045) with an average change of 7.23. LA peak systolic strain rate, and late diastolic strain rate did not show any significant change with time in both groups. Yet, a significant increase was seen in LA early diastolic strain rate between T0 to T2 (p=0.017) in G1 but not G2. No significant changes were seen in the RA strain parameters in both groups. Conclusion In patient with a reduction in LV function, a significant change was noted in the left atrial contraction strain and early diastolic strain rate with incremental doses of doxorubicin. These changes shows the close relationship between the LA and LV, and the importance of LA in providing a compensatory mechanism for a decline in LV function secondary to anthracycline cardiotoxicity. Funding Acknowledgement Type of funding source: None

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Circumferential deformation in diagnosis and risk assessment of patients with left ventricular non-compaction

European Heart Journal ◽

10.1093/ehjci/ehaa946.2073 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Anwer ◽

P.S Heiniger ◽

S Rogler ◽

D Cassani ◽

L Rebellius ◽

...

Keyword(s):

Longitudinal Strain ◽

Circumferential Strain ◽

Strong Association ◽

Global Longitudinal Strain ◽

Diagnostic Algorithm ◽

Left Ventricular ◽

Deformation Analysis ◽

Funding Source ◽

Apical Rotation ◽

Increased Risk

Abstract Introduction Echocardiography-based deformation analysis is used for studying left ventricular (LV) mechanics and have an emerging role in the diagnosis of cardiomyopathies. Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterised by a two-layered LV myocardium with prominent trabeculae separated by deep recesses perfused from the LV cavity. Left ventricular hypertrabeculation (LVHT) may be difficult to differentiate from LVNC. In this study, we aim to develop a diagnostic algorithm based on the circumferential deformation (CD) of LVNC, LVHT and controls; and find their associations with LVNC outcomes. Methods We compared 45 LVNC patients, 45 LVHT individuals, and 45 matched healthy controls. LVNC was diagnosed according to current echocardiographic criteria. LVHT was defined as presence of three or more trabeculae in the LV apex visualised in both parasternal short axis and apical views. Controls had a normal echocardiographic examination and no evidence of cardiovascular disease. Strain analysis was performed using TomTec Image-Arena (version 4.6). Results Receiver observer characteristics curve (ROC) analyses revealed that GCS <22.3% differentiated LVNC from control or LVHT. In individuals with global circumferential strain (GCS) below 22.3%, an apical peak circumferential strain (PCS) cut-off value of 18.4% differentiated LVNC [<18.4%] and LVHT [≥18.4%] (fig. 1). An independent echocardiographer (Table 1) performed blind validation of diagnosis on 32 subjects from each group. Combined endpoint of cardiovascular events in LVNC (CVE) is described in figure 2. Multi-variate regression analyses have shown that GCS was associated with 11-fold increased risk of CVE independent of LVEF and NC:C ratio, while global longitudinal strain (GLS) displayed only 2-fold increased risk. Regional basal and apical peak circumferential or longitudinal strain, left ventricular twist, basal-apical rotation ratio have shown significant associations (Fig. 3). Conclusions A diagnostic algorithm with GCS and aPCS (threshold value 18.4%) differentiates LVNC from LVHT and control with very high sensitivity and specificity independent of additional echocardiographic or clinical information. Circumferential strain derived parameters exhibit a very strong association with outcomes independent of LVEF and NC:C ratio. Absence of CVE in LVHT provides further evidence on the distinct nature of LVNC and LVHT. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): 2018 research grant from the Swiss Heart Foundation

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Association between Reduced estimated Glomerular Filtration Rate and Cardiac Structure and Function in Patients with Essential Hypertension

10.22541/au.163428484.43885905/v1 ◽

2021 ◽

Author(s):

Liying Mu ◽

Lu Chen ◽

juan du ◽

Hua Jiang ◽

Caixia Guo ◽

...

Keyword(s):

Essential Hypertension ◽

Left Atrial ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Left Ventricular ◽

Structure And Function ◽

Right Atrial ◽

Cardiac Structure ◽

Cardiac Structure And Function ◽

And Function

Objectives To investigate the relationship between small reductions in estimated glomerular filtration rate (eGFR) and cardiac structure and function in patients with essential hypertension. Methods The study group included 565 patients with essential hypertensive. eGFR was calculated by EPI equation and cardiac structure and function were assessed using echocardiography. The participants were divided into three groups: eGFR ≥90 mL/min /1.73 m2, 60-89 mL/min/1.73 m2, and 30-59 mL/min /1.73 m2. Pearson correlation analysis and multiple stepwise linear regression analysis were performed to evaluate associations between eGFR and echocardiogram parameters. Results Compared with patients with eGFR ≥ 90 mL/min/ 1.73 m2, those with eGFR 60-89 mL/min/ 1.73 m2 and 30-59 mL/min/ 1.73 m2 had higher left ventricular end-diastolic diameter (LVEDD) (p=0.019), mitral valve E wave (p=0.004), left atrial diameter (LAD) (p=0.001), right atrial diameter (RAD) (p=0.001), right ventricular diameter (RVD) (p=0.001) and lower left ventricular ejection fraction (LVEF) (p=0.01). After further adjustment for traditional cardiovascular risk factors including systolic and diastolic blood pressure, BMI, diabetes, dyslipidemia and smoking, eGFR was still associated with LVEF (p＜0.001), LAD (p＜0.001) and RAD (p=0.003). Conclusion Among patients with essential hypertension, even mildly reduced renal function is independently associated with greater cardiac remodeling, indicated by left atrial and right atrial enlargement, and worse left ventricular systolic function.

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