scholarly journals EXPRESS: Influence of advanced pulmonary vascular remodeling on accuracy of echocardiographic parameters of left ventricular filling pressure

2020 ◽  
pp. 204589402098372
Author(s):  
Yasuyuki Chiba ◽  
Hiroyuki Iwano ◽  
Sanae Kaga ◽  
Mio Shinkawa ◽  
Murayama Michito ◽  
...  
Keyword(s):  
Left Atrial Volume ◽  
Right Heart Catheterization ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Vascular Lesions ◽  
Volume Index ◽  
Control Group ◽  
Heart Catheterization ◽  
Left Atrial Volume Index ◽  
Echocardiographic Parameters

Evaluation of left ventricular (LV) filling pressure plays an important role in the clinical management of pulmonary hypertension (PH). However, the accuracy of echocardiographic parameters for the determination of LV filling pressure in the presence of pulmonary vascular lesions has not been fully addressed. We retrospectively investigated 124 patients with PH due to pulmonary vascular lesions (noncardiac PH group) and 113 patients with ischemic heart disease (control group) who underwent right heart catheterization and echocardiography. The noncardiac PH group was subdivided into less-advanced and advanced groups according to median pulmonary vascular resistance (PVR). Pulmonary artery wedge pressure (PAWP) was determined as LV filling pressure. As echocardiographic parameters of LV filling pressure, the ratio of early- (E) to late-diastolic transmitral flow velocity (E/A), ratio of E to early-diastolic mitral annular velocity (E/e'), and left atrial volume index (LAVI) were measured. In the less-advanced noncardiac PH and control groups, positive correlations were observed between PAWP and E/A (R=0.41, P=0.002 and R=0.71, P<0.001 respectively) and LAVI (R=0.53, P<0.001 and R=0.41, P<0.001), whereas in the advanced noncardiac PH group, PAWP was only correlated with LAVI (R=0.27, P=0.032). In the controls, only PAWP determined E (β=0.48, P<0.001), whereas both PAWP and PVR were independent determinants of E (β=0.29, P<0.001 and β=–0.28, P=0.001, respectively) in the noncardiac PH group. In conclusion, in the presence of advanced pulmonary vascular lesions, conventional echocardiographic parameters may not accurately reflect LV filling pressure. Elevated PVR would lower the E, even when PAWP is elevated, resulting in blunting of echocardiographic parameters for the detection of elevated LV filling pressure.

Abstract 13798: Influence of Advanced Pulmonary Vascular Remodeling on Accuracy of Echocardiographic Parameters of Left Ventricular Filling Pressure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yasuyuki Chiba ◽  
Hiroyuki Iwano ◽  
Sanae Kaga ◽  
mio shinkawa ◽  
Michito Murayama ◽  
...  
Keyword(s):  
Left Atrial Volume ◽  
Right Heart Catheterization ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Vascular Lesions ◽  
Volume Index ◽  
Control Group ◽  
Heart Catheterization ◽  
Left Atrial Volume Index ◽  
Echocardiographic Parameters

Introduction: Evaluation of left ventricular (LV) filling pressure (FP) plays an important role in the clinical management of pulmonary hypertension (PH). However, the accuracy of echocardiographic parameters for the estimation of LV FP in the presence of pulmonary vascular lesions has not been fully addressed. Methods: We investigated 87 patients diagnosed with PH due to pulmonary vascular lesions (non-cardiac PH; PH NC ) (PH NC group) and 117 patients with ischemic heart disease without reduced LV ejection fraction (<40%) (control group). Mean pulmonary arterial wedge pressure (PAWP) and pulmonary vascular resistance (PVR) were obtained by right heart catheterization. As echocardiographic parameters of LV FP, the ratio of early- (E) to late-diastolic transmitral flow velocity (E/A), ratio of E to early-diastolic mitral annular velocity (E/e'), and left atrial volume index (LAVI) were measured. The PH NC group was subdivided into non-severe and severe groups according to median PVR (5.3 Wood units). Results: PAWP was 12±5 mmHg in controls, 9±4 mmHg in non-severe PH NC , and 8±3 mmHg in severe PH NC . In the control and non-severe PH NC groups, positive correlations were observed between PAWP and E/A (R=0.66 and R=0.41, respectively), E/e' (R=0.36 and R=0.33), and LAVI (R=0.38 and R=0.62). In contrast, in the severe PH NC group, PAWP was only correlated with LAVI (R=0.41, p=0.006). In the control group, PAWP determined E (β=0.45, p<0.001) but PVR did not, whereas both PAWP and PVR were independent determinants of E (β=0.32, p=0.001; and β=-0.35, p<0.001, respectively) in the PH NC group. Conclusions: In the presence of advanced pulmonary vascular lesions, conventional Doppler echocardiographic parameters may not accurately reflect LV FP. Importantly, elevated PVR would lower the E value, even when PAWP is elevated, resulting in blunting of these parameters for the detection of elevated LV FP. LAVI might be a reliable parameter for estimating LV FP in patients with severe non-cardiac PH.

Determinants of coronary microvascular dysfunction in symptomatic hypertrophic cardiomyopathy

2008 ◽  
Vol 294 (2) ◽  
pp. H986-H993 ◽  
Author(s):  
Paul Knaapen ◽  
Tjeerd Germans ◽  
Paolo G. Camici ◽  
Ornella E. Rimoldi ◽  
Folkert J. ten Cate ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Coronary Arteries ◽  
Left Atrial Volume ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Volume Index ◽  
Coronary Microvascular Dysfunction ◽  
Heart Catheterization ◽  
Left Atrial Volume Index ◽  
Lv Mass

Impaired hyperemic myocardial blood flow (MBF) in hypertrophic cardiomyopathy (HCM), despite normal epicardial coronary arteries, results in microvascular dysfunction. The aim of the present study was to determine the relative contribution of extravascular compressive forces to microvascular dysfunction in HCM. Eighteen patients with symptomatic HCM and normal coronary arteries and 10 age-matched healthy volunteers were studied with PET to quantify resting and hyperemic MBF at a subendocardial and subepicardial level. In HCM patients, MRI was performed to determine left ventricular (LV) mass index (LVMI) and volumes, echocardiography to assess diastolic perfusion time, heart catheterization to measure LV outflow tract gradient (LVOTG) and LV pressures, and serum NH2-terminal pro-brain natriuretic peptide (NT-proBNP) as a biochemical marker of LV wall stress. Hyperemic MBF was blunted in HCM vs. controls (2.26 ± 0.97 vs. 2.93 ± 0.64 ml·min−1·g−1, P < 0.05). In contrast to controls (1.38 ± 0.15 to 1.25 ± 0.19, P = not significant), the endocardial-to-epicardial MBF ratio decreased significantly in HCM during hyperemia (1.20 ± 0.11 to 0.88 ± 0.18, P < 0.01). This pattern was similar for hypertrophied septum and lateral wall. Hyperemic MBF was inversely correlated with LVOTG, NT-proBNP, left atrial volume index, and LVMI (all P < 0.01). Multivariate regression analysis, however, revealed that only LVMI and NT-proBNP were independently related to hyperemic MBF, with greater impact at the subendocardial myocardial layer. Hyperemic MBF is more severely impaired at the subendocardial level in HCM patients. The level of impairment is related to markers of increased hemodynamic LV loading conditions and LV mass. These observations suggest that, in addition to reduced capillary density caused by hypertrophy, extravascular compressive forces contribute to microvascular dysfunction in HCM patients.

scholarly journals P1506 The correlation between left atrial volume index and cerebrovascular stroke

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Almaghraby ◽  
M Abdelnabi ◽  
T Kemaloglu Oz ◽  
Y Saleh ◽  
H Shehata ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Control Group ◽  
P Value ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Cerebrovascular Stroke

Abstract OnBehalf YIG-CVR Introduction Increased left atrial (LA) size was associated with poor cardiovascular outcomes such as the development of heart failure, atrial fibrillation (AF), and stroke in the elderly. Aim of the work To determine the relation between left atrial volume index (LAVI) and the occurrence of ischemic cerebrovascular stroke (CVS) in patients with sinus rhythm. Patients and Methods A prospective analysis of the data of patients admitted to a tertiary care center. Left atrial volume index (LAVI) was measured in 1222 patients admitted to our center with first attack of acute ischemic cerebrovascular stroke (CVS) and the data was matched with 1222 patients admitted by diagnoses other than acute ischemic stroke. Patients with valvular heart diseases, history of AF and with known cardio-embolic source of stroke as left ventricular thrombi or masses were excluded from both groups. Results The mean age was 61.1 ± 14.4 years in the CVS group and 61.5 ± 12.4 years in the control group, males were 806 (71.43%) in the CVS group and 852 (73.47%) in the control group. LAVI was 35 ± 10.3 ml/m2 in the CVS group while it was only 25.8 ± 6.4 ml/m2 in the control group which was statistically significant (P value= 0.002). Conclusion LAVI is a strong parameter that can be used to predict the occurrence of CVS in patients with sinus rhythm. Total (n = 2444) Acute CVS (n = 1222) No CVS (n = 1222) P-value Age (years) 61.1 ± 14.4 61.5 ± 12.4 0.75 Sex (Males) 806 (66%) 852 (70%) 0.65 Diabetes 655 (53.6%) 603 (49.3%) 0.6 Hypertension 702 (57.5%) 675 (55.2%) 0.55 Smoking 599 (49%) 564 (46.2%) 0.71 Dyslipidemia 310 (25.4%) 299 (24.5%) 0.81 Mean BP (mmHg) 122 ± 15 119 ± 17 0.88 Heart rate (bpm) 82 ± 16 85 ± 18 0.76 Hemoglobin (g/dl) 12.3 ± 1.3 12.9 ± 1.7 0.61 Platelets (103/l) 255 ± 110 235 ± 95 0.35 INR 1.15 ± 0.11 1.09 ± 0.18 0.75 Ejection fraction (%) 55 ± 12 51 ± 11 0.41 LAVI (ml/m2) 35 ± 10.3 25.8 ± 6.4 0.002* Results are represented as number (%) or mean ± standard deviation, BP = Blood Pressure, INR = International Normalization Ratio, * significant P value &lt; 0.05 Abstract P1506 Figure. Comparison between both groups

scholarly journals Left Atrial Volume Index in Diagnosis of Heart Failure With Preserved Ejection Fraction

2021 ◽  
Author(s):  
Xingxue Pang ◽  
Ruoyi Liu ◽  
Li Xu ◽  
Xin Tao ◽  
Xuezeng Hao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Pressure ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Control Group ◽  
Preserved Ejection Fraction ◽  
Left Atrial Volume Index ◽  
Reduced Ejection Fraction

Abstract Objective To assess the value of left atrium volume index（LAVI）for diagnosing heart failure with preserved ejection fraction (HFpEF) based on the invasive determination of left ventricular end-diastolic pressure (LVEDP).Methods A total of 710 cases of patients with dyspnea (LVEF≥50%) were enrolled in this retrospective study. Left ventricular end-diastolic pressure (LVEDP) was measured through selective coronary angiography. According to the value of LVEDP, cases were divided into the HFpEF group ( LVEDP≥15mmHg) and the control group (LVEDP<15mmHg). LAVI was calculated based on cardiac compartment diameter, as measured by echocardiography, and body surface area (BSA). Differences of LAVI between the HFpEF group and the control group, and between subgroups in the HFpEF group were analyzed.Results The difference in LAVI between the control group and the HFpEF group was statistically significant (41.35±2.28vs.46.78±2.63ml/m2, p=0.008). LVEDP was positively correlated with LAVI (Pearson: r=0.787, P＜0.001). When LAVI took the best cutoff value of 43.7 mm/m2, the sensitivity and specificity of diagnosis of HFpEF were 92.0% and 88.9%. When the boundary value of LAVI was from 41.7 to 45.7 mm/m2, the sensitivity of the diagnosis of ejection fraction retention heart failure was from 97.4% to 64.4% and the specificity was from 51.2.0% to 92.2%.Conclusion In patients with dyspnea after exclusion of heart failure with reduced ejection fraction (HFrEF), LAVI is positively correlated with LVEDP. LAVI can be used to diagnose HFpEF when HFrEF is excluded.

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.

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