Correlation of Left Atrial Strain and Doppler Measurements with Invasive Measurement of Left Ventricular End-Diastolic Pressure in Patients Stratified for Different Values of Ejection Fraction

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 <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

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

European Heart Journal ◽

10.1093/eurheartj/ehz745.0777 ◽

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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Left atrial strain reservoir in monitoring heart transplant paediatric patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.147 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

N Borrelli ◽

M Panebianco ◽

G Di Salvo ◽

S Alfieri ◽

D De Angelis ◽

...

Keyword(s):

Cardiac Catheterization ◽

Heart Transplant ◽

Left Atrial ◽

Diastolic Pressure ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Atrial Strain ◽

Funding Sources ◽

Paediatric Age ◽

Atrial Strain

Abstract Funding Acknowledgements Type of funding sources: None. Background In heart transplant (HT) patients, high LV filling pressure is considered a marker of rejection and predictive of increased mortality. Purpose Our study aims to correlate echocardiographic parameters to left-ventricular end diastolic pressure (LVEDP) at cardiac catheterization in transplant recipients. Methods This was a retrospective study of 50 HT patients (54% male) who underwent heart transplantation in paediatric age (0-18 years-old). The echocardiographic evaluation was performed within three weeks from the left heart cardiac catheterization. From apical view, we measured: left atrial strain (LAS) indices [atrial contraction (εac), LA filling (reservoir phase, εres), and LA passive emptying (conduit phase, εcon)], mitral doppler E/A, E/e’, global longitudinal strain (LVGLS) and strain rate. Results Median LVEDP was 10 mmHg (IQR 8.25-12 mmHg) and had the best correlation with decreased εres (r= -0.56, p < 0.0001). The other LAS indices and mitral E/e’ correlated less strongly with LVEDP (εac: r= -0.42, p = 0.004; εcon: r= -0.55, p= 0.0001; E/e’: r = 0.28, p = 0.04). E/A, LVGLS and LVGLS rate did not correlate with LVEDP. By ROC analysis, εres ≤ 16.3% was predictive of elevated LVEDP with a good sensitivity (86%) and moderate specificity (57%). A multivariate analysis produced εres as the best predictor (p = 0.0001) for high LVEDP. Conclusions Non-invasive εres seems to be a good surrogate of invasive LVEDP. Monitoring εres may be of value in HT patients to survey for rejection and graft disfunction. Abstract Figure. Scatter plots LVEDP-εres correlation

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Abstract 15681: Reduced Left Atrial Strain is Associated With the Development of Atrial Arrhythmias in Hospitalized Patients With COVID-19

Circulation ◽

10.1161/circ.142.suppl_3.15681 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Erin Goerlich ◽

Anum S Minhas ◽

Andreas S Barth ◽

Katherine C Wu ◽

Allison G Hays

Keyword(s):

Ejection Fraction ◽

Left Atrial ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Hospitalized Patients ◽

Inpatient Setting ◽

Atrial Arrhythmias ◽

Contributing Factors ◽

Left Atrial Strain ◽

Atrial Strain

Introduction: Coronavirus Disease 2019 (COVID-19) is a pandemic with frequent cardiovascular (CV) complications, including cardiac arrhythmias. However, little is known about contributing factors to the development of new atrial tachyarrhythmias (ATs) in the inpatient setting. Left atrial strain (LAS) is a novel transthoracic echocardiography (TTE) measure of LA myocardial deformation and predicts arrhythmias. We aimed to compare clinical and echocardiographic variables including LAS in hospitalized patients with COVID-19 who developed new ATs compared to matched controls without arrhythmias. Methods: We retrospectively studied 42 patients hospitalized with COVID-19 who underwent clinical TTE. During admission, 20 patients without prior arrhythmia developed new ATs (including sustained atrial fibrillation/flutter/tachycardia, and undifferentiated supraventricular tachycardia) (cases) and were compared to 22 age and sex-matched COVID-19 patients without arrhythmias (controls). TTEs were analyzed for reservoir (peak longitudinal) LAS using 2D-speckle tracking and LA ejection fraction (LAEF) offline using TomTec software. Comparisons were made using Chi-square and t-tests as appropriate. Results: Mean age was 65±14 years, and 40% were women. There were no significant differences in CV risk factors, BMI, troponin or peak inflammatory markers between cases and controls. LAS was overall lower than normal and significantly lower in cases compared to controls (23.5±7.5% vs 31.0±6.0% respectively, P =0.001; Fig 1). There were no significant differences in left ventricular (LV) ejection fraction (LVEF), LV global longitudinal strain (GLS), LAEF, shock or death. Conclusions: COVID-19 patients who developed new ATs have lower LAS on TTE than patients without atrial arrhythmias. LAS may be a sensitive marker for identifying patients with COVID-19 at risk for ATs compared to LVEF, LV GLS, and LAEF. Larger confirmatory studies are warranted.

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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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Mitral early-diastolic inflow peak velocity (E)-to-left atrial strain ratio as a novel index for predicting elevated left ventricular filling pressures in patients with preserved left ventricular ejection fraction

Cardiovascular Ultrasound ◽

10.1186/s12947-021-00248-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

You Zhou ◽

Cai-Ming Zhao ◽

Zhen-Ya Shen ◽

Xin Zhao ◽

Bing-Yuan Zhou

Keyword(s):

Ejection Fraction ◽

Left Atrial ◽

Test Group ◽

Strain Ratio ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Left Atrial Strain ◽

Ventricular Ejection Fraction ◽

Atrial Strain ◽

Ventricular Filling

Abstract Objectives We sought to explore the relationship between an index of left ventricular diastolic function parameters combined with left atrial strain and the diastolic function of patients with preserved ejection fraction. Methods We prospectively enrolled 388 patients with left ventricular ejection fraction (LVEF) ≥ 50%, 49 of whom underwent left heart catherization. Transthoracic echocardiography was performed within 12 h before or after the procedure. Left atrial (LA) strain was obtained by speckle tracking echocardiography. These patients served as the test group. The remaining patients (n = 339) were used to validate the diagnostic performance of the mitral early-diastolic inflow peak velocity (E)-to-left atrial reservoir strain ratio (E/LASr) in left ventricular diastolic dysfunction. Results Invasive measurements of LV end-diastolic pressure (LVEDP) demonstrated that the E/LASr ratio was increased in patients with elevated LVEDP [ 2.0 (1.8–2.2) vs 3.0 (2.6–4.0), p < 0.001] in the test group (n = 49). After adjusting for age, mitral A, E/e' ratio and β-blocker use, the E/LASr ratio was an independent predictor of elevated LVEDP and showed good diagnostic performance in determining elevated LVEDP [area under the curve (AUC) 0.903, cutoff value 2.7, sensitivity 74.2%, specificity 94.4%]. In the validation group (n = 339), the E/LASr ratio also performed well in diagnosing elevated left atrial pressure (LAP) (AUC 0.904, cutoff value 3.2, sensitivity 76.5%, specificity 89.0%), while with a cut-off value of 2.7, the E/LASr ratio showed high accuracy in discriminating elevated LAP. In addition, E/LASr was a good index of excellent diagnostic utility (AUC: 0.899 to 0.996) in the categorization of diastolic dysfunction grades. Regarding the clinical relevance of this index, the E/LASr ratio could accurately diagnose HF with preserved ejection fraction (HFpEF) (0.781), especially in patients with “indeterminate” status (AUC: 0.829). Furthermore, an elevated E/LASr ratio was significantly associated with the risk of rehospitalization due to major adverse cardiac events (MACEs) within one year (odds ratio: 1.183, 95% confidence interval: 1.067, 1.312). Conclusions In patients with EF preservation, the E/LASr ratio is a novel index for assessing elevated left ventricular filling pressure with high accuracy.

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