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.

Left atrial deformation in estimating left atrial pressure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Lindqvist ◽  
E Tossavainen ◽  
M.Y Henein
Keyword(s):  
Pulmonary Hypertension ◽  
Strain Rate ◽  
Left Atrial ◽  
Right Heart Catheterization ◽  
Left Ventricular ◽  
Valve Disease ◽  
Heart Catheterization ◽  
Clinical Value ◽  
Left Atrial Strain ◽  
Atrial Strain

Abstract Background In the absence of mitral valve disease, elevated left atrial (LA) pressure reflects reduced left ventricular (LV) compliance and raised diastolic pressures, hence an important explanation for exertional breathlessness. Methods We studied 145 symptomatic patients, age 63±14 years, 55 males, using conventional transthoracic echocardiography guidelines protocol, including LA and LV myocardial deformation investigations along with simultaneous right heart catheterization using conventional techniques. From invasive measurements, pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP) were measured and pulmonary vascular resistance (PVR) calculated. No patient had more than mild mitral or aortic valve disease. Results LA strain rate during atrial systole (LASRa) was the strongest correlate with PCWP (r2=−0.39, p&lt;0.001), over and above LASR during LV systole (LASRs) and peak LA longitudinal strain (PALS) (r2=−0.21 and −0.19, respectively, p&lt;0.001 for both). Both LASRa and PALS predicted elevated PCWP &gt;15 mmHg but only modestly (AUC= 0.55 and 0.52). The relationship between LASRa and PCWP was stronger in patients with post-capillary pulmonary hypertension compared to those with pre-capillary pulmonary hypertension (r2=0.21 vs. r2=0.02). However, the strongest relationship between LASRa and PCWP was in patients with LA volume &gt;34 ml/m2 (r2=0.59, p&lt;0.001, see figure) but other strain relationships did not improve after only including patients with increased LA volume. Finally, LASRa correlated modestly with the respective LVSRa (r=0.53, P&lt;0.01), and to lesser extent with other cavity interaction correlations (r=0.26–0.48, p&lt;0.01). Conclusion Despite being somehow related to ventricular function, left atrial strain rate during atrial contraction is the closest correlate to PCWP, particularly in patients with dilated LA cavity. These data should be of significant clinical value in daily management of symptomatic patients. LASRaecho and PCWPrhc in patients with d Funding Acknowledgement Type of funding source: None

scholarly journals Left atrial strain rate estimates PCWP

2015 ◽  
Vol 1 (1) ◽  
pp. 25 ◽  
Author(s):  
Michael Henein ◽  
Erik Tossavainen ◽  
Stefan Söderberg ◽  
Christer Grönlund ◽  
Manuel Gonzalez ◽  
...  
Keyword(s):  
Left Atrial ◽  
Tissue Doppler ◽  
Right Heart Catheterization ◽  
Structure And Function ◽  
Heart Catheterization ◽  
Left Atrial Strain ◽  
Filling Fraction ◽  
Atrial Strain ◽  
And Function ◽  
Atrial Systole

<p><span>Objective: </span>Raised left atrial (LA) pressure is a common pathway for many pathologies and is known for its complications. It has a direct effect on LA cavity size and potentially also its function. We hypothesized that raised LA pressure, as shown by pulmonary capillary wedge pressure (PCWP), correlates with severity of global LA deformation abnormalities during atrial systole (LASRa).</p><p>Design and Patients: We prospectively studied 46 consecutive patients, mean age 61 +/-13 years, 17 males, of various etiologies who underwent right heart catheterization and simultaneous Doppler echocardiography using spectral, tissue Doppler and speckle tracking echocardiography techniques for assessing LA structure and function.</p><p><span>Results: </span>PCWP correlated with direct measurements of LA structure and function: LA volume (r= 0.43, p&lt;0.01) and LASRa (r=0.79, p&lt;0.001). PCWP correlated also with other indirect measures of LA pressure such as E/A (r=0.65, p&lt;0.001), E wave deceleration time (r=0.54, p&lt;0.001), E/e’ (r=0.49, p&lt;0.001) and LA systolic filling fraction (r=0.52, p&lt;0.001). However, LASRa together with LA systolic filling fraction, had the highest areas under the curve (0.83 and 0.87, respectively) for identifying patients with PCWP &gt; 15 mmHg.</p><p><span>Conclusion: </span>PCWP correlates with LA deformation rate during atrial systole and to a higher extent than conventional Doppler measures of raised LA pressures. These findings should have significant clinical implications in correctly identifying breathless patients due to raised LA pressure.</p><p> </p>

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.

Abstract 5664: Left Atrial Strain In Patients With Atrial Fibrillation: Relationship To Fibrosis By Delayed Enhancement-MRI

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Suman S Kuppahally ◽  
Robert S Oakes ◽  
Eric N Fish ◽  
Eugene Kholmovski ◽  
Sathya Vijayakumar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Strain Rate ◽  
Left Atrial ◽  
Delayed Enhancement ◽  
Left Atrial Strain ◽  
Chamber View ◽  
Strain And Strain Rate ◽  
Procedural Success ◽  
Atrial Strain

Introduction: The extent of left atrial (LA) wall fibrosis detected by delayed enhancement (DE)-cardiac MRI prior to catheter ablation of atrial fibrillation (AF) appears to predict procedural success. However, it is currently unknown how the degree of fibrosis affects atrial mechanical function. Methods: Prior to catheter ablation of AF, 31 patients underwent DE-CMRI and 2-dimensional transthoracic echocardiography. 3D segmentation of LA was performed and the degree of fibrosis was determined using a semi-automated quantification algorithm. Longitudinal mid-septal and mid-lateral LA wall velocity, strain and strain rate were measured during ventricular systole from the apical 4-chamber view by velocity vector imaging. Results : There was greater percent of fibrosis as LA maximum (R = 0.4, p = 0.05) and minimum (R=0.52, p = 0.008) volumes increased. Figure shows examples of DE-CMRI and strain curves (C) for two patients: Patient 1(A) with mild fibrosis and patient 2 (B) with extensive fibrosis. Patient 1 shows much larger strain than patient 2. Larger LA volumes correlated inversely with maximal LA mid-lateral systolic wall strain (p < 0.005). The percent fibrosis also correlated inversely with maximal LA mid-lateral systolic wall strain (R=0.56, p < 0.005) and the systolic strain rate (R = 0.58, p = 0.002). Conclusion: LA strain and strain rate can be assessed using standard echocardiographic gray scale images. LA strain is related to both atrial volumes and fibrosis, which are markers of atrial disease progression. This relationship may represent changes in the properties of LA substrate. These novel imaging approaches may be helpful in predicting outcomes in patients with AF.

Abstract 15161: Increased Right Atrial Stiffness in Patients With Heart Failure With Preserved Ejection Fraction and Pulmonary Hypertension

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jessie van Wezenbeek ◽  
Arno van der Bovenkamp ◽  
Jeroen N Wessels ◽  
Sophia-Anastasia Mouratoglou ◽  
Marie Jose Goumans ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Right Heart Catheterization ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Preserved Ejection Fraction ◽  
Chamber View ◽  
Patients With Heart Failure ◽  
Pulmonary Arterial

Background: Patients with Heart Failure with preserved Ejection Fraction (HFpEF) and Pulmonary Hypertension (PH) have increased right atrial (RA) pressures. Whether the higher RA pressures are related to increased afterload or overall stiffening of the heart is unknown. The aim of this study is to gain further insight into the right atrium in HFpEF-PH. Methods: This is a retrospective analysis of patients with HFpEF (no PH), HFpEF-PH and Pulmonary Arterial Hypertension (PAH) that underwent right heart catheterization and cardiac magnetic resonance (CMR) imaging. CMR was used to determine RA function by quantifying volume and strain on the 4-chamber view. Total, passive and active RA emptying fraction (RAEF) were calculated. RA stiffness was calculated by determining the slope of maximum and minimum pressure during v-wave and minimal and maximal RA volumes. Groups were compared with ANOVA and post-hoc comparison with Bonferroni correction. Results: 176 patients were included: 13 HFpEF, 33 HFpEF-PH and 130 PAH patients. Although afterload was lower in PAH and higher in HFpEF patients, as shown by mean pulmonary arterial pressure (mPAP) (41 ± 2 mmHg in HFpEF-PH vs 53 ± 21 mmHg in PAH vs 19 ± 1 mmHg in HFpEF, p<0.001) and pulmonary vascular resistance (PVR) (2.3 ± 0.3 wu/m 2 in HFpEF-PH vs 5.7 ± 0.2 wu/m 2 in PAH vs 0.4 ± 0.06 wu/m 2 in HFpEF, p<0.001), mean RA pressure was significantly higher in HFpEF-PH patients compared to both groups (Figure 1A). HFpEF-PH patients had significantly increased RA stiffness compared to HFpEF and PAH patients (Figure 1B). Total RAEF was reduced in HFpEF-PH compared to PAH and HFpEF patients: passive RAEF was similar, but active RAEF was slightly reduced in HFpEF-PH (Figure 1C). This was in line with measurements of RA longitudinal strain (Figure 1D). Conclusions: Despite lower afterload, HFpEF-PH patients have worse RA function and increased RA stiffness compared to PAH. Higher RA pressures in HFpEF-PH may reflect additional stiffening of the heart.

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) &gt; 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 &lt; 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 &lt; 0.001) (Fig. a,b). At a cut-off value of 18.0%, LA lateral wall strain could predict elevated PCWP &gt; 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 &lt; 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 &lt; 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

scholarly journals Comparison of clinical and echocardiographic scores to predict pre-capillary pulmonary hypertension

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Fontes Oliveira ◽  
MI Oliveira ◽  
S Cabral ◽  
S Torres ◽  
A Reis ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Left Ventricle ◽  
Left Atrial ◽  
Vena Cava ◽  
Heart Catheterization ◽  
Left Heart ◽  
Discrimination Power ◽  
Left Ventricle Mass ◽  
Gold Standard Method

Abstract Funding Acknowledgements Type of funding sources: None. Background Right heart catheterization (RHC) is the gold-standard method to confirm the diagnosis of Pulmonary Hypertension (PH) and to differentiate between pre- and post-capillary PH. However, RHC is an invasive and sometimes low-available procedure, which cannot be performed in all the patients with suspected PH. Clinical and echocardiographic scores have been developed to predict pre-capillary PH. We aimed to compare the performance of four of these scores in a population with suspected PH. Methods We retrospectively included consecutive patients who underwent RHC for suspected PH. If the non-invasive evaluation was clearly suggestive of left heart disease, RHC was dispensed being considered not clinically relevant. We also excluded patients with congenital heart disease. We compared the performance of four scores to predict pre-capillary PH: Score 1 (Opotowsky et al.), score 2 (Richter et al.), score 3 (Berthelot et al.) and score 4 (D’Alto et al.. Results Of the 142 included patients, 76 patients had pre-capillary PH, 42 had post-capillary PH and 24 patients did not meet invasive criteria for PH. We were able to perform the aforementioned scores in the majority of our patients (82% for score 1, 100% for score 2, 98% for score 3 and 83% for score 4). The AUC to predict pre-capillary PH using these scores were 0.74 for score 1, 0.77 for score 2, 0.82 for score 3 and 0.70 for score 4 (p = 0.37). Using the best cut-off points for each score, the score 3 correctly classified the highest percentage of patients (75.5%), with a sensitivity of 92% and a specificity of 60% to predict pre-capillary PH. Conclusion Combined clinical and echocardiographic characteristics can be used to predict pre-capillary PH with a fairly good performance. Score 3 (Berthelot et al.) was the score with the highest discrimination power. Validation of these scores in larger cohorts of patients with suspected PH are needed. Clinical and echocardiographic characteristics Interpretation Opotowsky et al. LA diameter (&lt;32 mm: +1, &gt;24 mm: -1), mid-systolic notch or acceleration time &lt;80 msec (+1), E/e’&gt;10 (-1) Score ≥ 0 has a sens. 100% and a spec. 62% for pre-capillary PH Richter et al. Age &gt; 68 years (+1), BMI &gt; 30 kg/m2 (+1), absence of RV enlargement (+1), LA enlargement (+1) Score &gt;4 predicted post-capillary PH (AUC 0.78) Berthelot et al. Atrial fibrillation (+2), diabetes mellitus (+1), LA enlargement (15 ≤ LAA &lt; 19: +1, 19 ≤ LAA &lt; 24: +2, ≥ 19 cm2: +3), RV end-diastolic area (&lt;27 cm2: +2), LV mass index (46 &lt; LVMI ≤ 62: +1, 62 &lt; LBMI ≤ 81: +2,&lt; 81 cm2: +3) Score &lt;5 ruled out post-capillary PH D’Alto et al E/e" ≤ 10 (+2), dilated non-collapsible IVC (+2), EI ≥ 1.2 (+1), right-to-left heart chamber dimension ratio &gt; 1 (+1), RV forming the heart apex (+1) Score ≥ 2 has a sens. 99% and a spec. 54% for pre-capillary PH (AUC 0.85) Table 1. The clinical and echocardiographic scores evaluated in this study. AUC: area under the curve, EI: eccentricity index, IVC: inferior vena cava, LA: left atrial, LAA: left atrial area, LV: left ventricle, LVMI: left ventricle mass index, PH: pulmonary hypertension, Sens.: sensibility, Spec.: specificity, RV: right ventricle Abstract Figure.

scholarly journals MRI feature tracking strain in pulmonary hypertension: utility of combined left atrial volumetric and deformation assessment in distinguishing post- from pre-capillary physiology

2021 ◽  
Author(s):  
Kai'En Leong ◽  
Luke Howard ◽  
Francesco Lo Guidice ◽  
Holly Pavey ◽  
Rachel Davies ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Atrial ◽  
Feature Tracking ◽  
Cross Sectional Study ◽  
Right Atrial ◽  
Peak Strain ◽  
Sectional Study ◽  
Left Atrial Strain ◽  
Cross Sectional ◽  
Atrial Strain

Abstract AimsPulmonary hypertension (PH) is dichotomized into pre- and post-capillary physiology by invasive catheterization. Imaging, particularly strain assessment, may aid in classification and be helpful with ambiguous haemodynamics. We sought to define cardiac MRI (CMR) feature tracking biatrial peak reservoir and biventricular peak systolic strain in pre- and post-capillary PH and examine the performance of peak left atrial strain in distinguishing the 2 groups compared to TTE.Methods and resultsRetrospective cross-sectional study from 1 Jan 2015 to 31 Dec 2020; 48 patients (22 pre- and 26 post-capillary) were included with contemporaneous TTE, CMR and catheterization. Mean pulmonary artery pressures were higher in the pre-capillary cohort (55 + 14 mmHg vs 42 + 9 mmHg; p<0.001) as was pulmonary vascular resistance (median 11.7 WU vs 3.7 WU; p<0.001). Post-capillary patients had significantly larger left atria (60 + 22 ml/m2 vs 25 + 9 ml/m2; p<0.001). There was no difference in right atrial volumes between groups (60 + 21 ml/m2 vs 61 + 29 ml/m2; p=0.694), however peak RA strain was lower in post-capillary PH patients (8.9 + 5.5% vs 18.8 + 7.0%; p<0.001). In the post-capillary group, there was commensurately severe peak strain impairment in both atria (LA strain 9.0 + 5.8%, RA strain 8.9 + 5.5%). CMR LAVi and peak LA strain had a multivariate AUC of 0.98 (95% CI 0.89-1.00; p<0.001) for post-capillary PH diagnosis which was superior to TTE.ConclusionCMR volumetric and deformation assessment of the left atrium can highly accurately distinguish post- from pre-capillary PH.

Pulmonary hypertension

2018 ◽  
Author(s):  
Robert MacKenzie-Ross ◽  
Karen K. K. Sheares ◽  
Joanna Pepke-Zaba
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Capillary Wedge Pressure ◽  
Pressure Measurement ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Pulmonary Capillary ◽  
Pathophysiological Condition ◽  
Wedge Pressure

Pulmonary hypertension (PH) is a haemodynamic and pathophysiological condition defined as mean pulmonary artery pressure ≥25 mm Hg at rest, assessed by right-heart catheterization (8–20 mm Hg is considered normal). A pulmonary capillary wedge pressure measurement of >15 mm Hg indicates a significant pulmonary venous component. PH is associated with a variety of causes. The current PH classification is helpful in understanding the different etiological, pathological, and treatment approaches.

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