Abstract 4201: A New Echo Index, Left Atrial Volume Index Over Late Diastolic Mitral Annulus Velocity Can Predict Elevated Left Ventricular Filling Pressures And Clinical Outcomes

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hun-Jun Park ◽  
Mahn-Won Park ◽  
Byung-Joo Shim ◽  
Mi-Jung Lee ◽  
Jae-Hong Park ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Clinical Outcomes ◽  
Left Atrial Volume ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Mitral Annulus Velocity ◽  
Ventricular Filling

Background: Another non-invasive method for prediction of elevated left ventricular filling pressure (LVFP) have attracted attention in clinical practice. Objectives: This study was to verify the clinical usefulness of left atrial volume index over late diastolic mitral annulus velocity (LAVi/A′) for the predictors of advanced (pseudonormal to restrictive physiology) diastolic dysfunction in the presence of elevated LVFP and clinical outcomes using right heart catheterization (RHC). Methods: 163 patients (95 men, mean age 61±13 years) with dyspnea underwent comprehensive Doppler echocardiography, RHC and B-type natriuretic peptide (BNP) measurement. Using ROC curve, we compared the areas under the curves (AUC) of LAVi/A′, transmitral early diastolic/annular velocity ratio (E/E′), and BNP level for the prediction of advanced diastolic dysfunction. During a median follow-up of 13.3 months, the incidence of the composite outcomes of cardiac death or re-hospitalization for heart failure was compared based on the optimal cut-off value of LAVi/A′. Results: The AUC of LAVi/A′ was comparable to that of BNP (0.91 vs. 0.90; p=0.78) and E/E′ (0.91 vs. 0.93; p=0.78) for prediction of advanced diastolic dysfunction. 68/163 (41.7%) patients had LAVi/A′ ≥4.0 and they had significantly higher BNP level and longer time difference between atrial reversal flow of pulmonary vein and transmitral late diastolic flow (AR dur -A dur ) compared with those of LAVi/A′ <4.0 (BNP: 1207±1212 vs. 176±365 pg/ml; AR dur -A dur: 24.6±21.1 vs. −3.3±15.9 msec, p<0.001, respectively). The LAVi/A′ had a reasonable correlation with mean PCWP (r=0.64, r 2 =0.41, p=0.001), which was comparable to that of E/E′ (r=0.60, r 2 =0.36, p=0.002). On Cox proportional hazard analysis, EF<50%, age ≥65 years, and LAVi/A′ ≥4.0 were independent outcome predictors with odds ratios of 4.8 (95% CI: 2.0 to 11.7), 3.8 (95% CI: 1.8 to 7.8), and 3.9 (95% CI: 1.5 to 9.8), respectively (p<0.01 for all). Conclusions: LAVi/A′ ≥4.0 is useful clinical predictors for advanced diastolic dysfunction in the presence of elevated LVFP and clinical outcomes.

Abstract 4205: Left Atrial Volume Index and Left Ventricular Geometry Independently Predict Mortality in 47,865 Patients with Preserved Ejection Fraction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Dharmendrakumar A Patel ◽  
Carl J Lavie ◽  
Richard V Milani ◽  
Hector O Ventura
Keyword(s):  
Ejection Fraction ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Mortality Prediction ◽  
Volume Index ◽  
Left Ventricular Geometry ◽  
Preserved Ejection Fraction ◽  
Atrial Volume ◽  
Left Atrial Volume Index

Background: LV geometry predicts CV events but it is unknown whether left atrial volume index (LAVi) predicts mortality independent of LV geometry in patients with preserved LVEF. Methods: We evaluated 47,865 patients with preserved EF to determine the impact of LAVi and LV geometry on mortality during an average follow-up of 1.7±1.0 years. Results: Deceased patients (n=3,653) had significantly higher LAVi (35.3 ± 15.9 vs. 29.1 ± 11.9, p<0.0001) and abnormal LV geometry (60% vs. 41%, p<0.0001) than survivors (n=44,212). LAVi was an independent predictor of mortality in all four LV geometry groups [Hazard ratio: N= 1.007 (1.002–1.011), p=0.002; concentric remodeling= 1.008 (1.001–1.012), p<0.0001; eccentric hypertrophy= 1.012 (1.006 –1.018), p<0.0001; concentric hypertrophy=1.017 (1.012–1.022), p<0.0001; Figure ]. Comparison of models with and without LAVi for mortality prediction was significant suggesting increased mortality prediction by addition of LAVi to other independent predictors (Table ). Conclusion: LAVi is higher and LV geometric abnormalities are more prevalent in deceased patients with preserved systolic function and are independently associated with increased mortality. LAVi predicts mortality independent of LV geometry and has synergistic influence on all cause mortality prediction in large cohort of patients with preserved ejection fraction.

P1486Semi-automated volume-strain loops: a new tool in TTE to assess diastolic dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Hubert ◽  
V Le Rolle ◽  
E Galli ◽  
A Hernandez ◽  
E Donal
Keyword(s):  
Left Atrial ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Atrial Volume ◽  
Volume Strain ◽  
Left Atrial Volume Index ◽  
Loop Area ◽  
Lv Volume

Abstract Aim This work aims to evaluate a novel semi-automatic tool for the assessment of volume-strain loops by transthoracic echocardiography (TTE). The proposed method was evaluated on a typical model of left ventricular (LV) diastolic dysfunction: the cardiac amyloidosis. Method 18 patients with proved cardiac amyloidosis were compared to 19 controls, from a local database. All TTE were performed using Vivid E9 or E95 ultrasound system. The complete method includes several steps: 1) extraction of LV strain full traces from apical 4 and 2 cavities views, 2) estimation of LV volume from these two traces by spline interpolations, 3) resampling of LV strain curves, determined for the same cardiac beat, (in apical 4-, 2- and 3- cavities views) as a function of pre-defined percentage increments of LV-volume and 4) calculation of the LV volume-strain loop area. (Figure 1, panel B) Results (Table 1): LVEF was similar between both groups whereas global longitudinal strain was significantly lower in amyloidosis group (−14.4 vs −20.5%; p<0.001). Amyloidosis group had a worse diastolic function with a greater left atrial volume index (51 vs 22ml/m2), a faster tricuspid regurgitation (2.7 vs 2.0 m/s), a greater E/e' ratio (17.3 vs 5.9) with a p<0.001 for all these indices. Simultaneously, the global area of volume-strain loop was significantly lower in amyloidosis group (36.5 vs 120.0%.mL). This area was better correlated with mean e' with r=0.734 (p<0.001) than all other indices (Figure 1, panel A). Table 1 Amyloidosis (N=18) Controls (N=19) p Global strain-volume loop area (%.mL) 36.5±21.3 120.0±54.2 <0.001 Global longitudinal strain (%) −14.4±3.8 −20.5±1.8 <0.001 Left ventricular ejection fraction (%) 62±7 65±5 0.08 Left atrial volume index (ml/m2) 51±22 22±5 <0.001 E/A 1.72±0.97 2.07±0.45 0.17 Mean e' 5.5±1.3 14.4±2.8 <0.001 Mean E/e' 17.3±5.4 5.9±1.4 <0.001 Tricuspid regurgitation velocity (m/s) 2.7±3.8 2.0±0.3 <0.001 Figure 1 Conclusion LV volume-strain loop area appears a very promising new tool to assess semi-automatically diastolic function. Future applications will concern the integration of LV volume-strain loop area as novel feature in machine-learning approach.

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