Non-Invasive Estimation of Left Ventricular Filling Pressure Based on Left Atrial Area Strain Measured With Transthoracic 3-Dimensional Speckle Tracking Echocardiography in Patients With Coronary Artery Disease

Patients with atrial fibrillation (AF) are frequently associated with reduced left ventricular (LV) diastolic dysfunction. It is still unclear whether reduced diastolic function is associated with the risk of left atrial (LA) thrombus in AF. The ratio of transmitral E velocity to mitral annular velocity (e′) is an echocardiographic estimate of diastolic LV filling pressure even under AF rhythm. We investigated whether reduced LV diastolic function is associated with the risk of LA thrombus in AF patients, using E/e′ ratio as an index. We enrolled consecutive 405 patients with non-valvular, paroxysmal or chronic AF, who underwent both transthoracic- (TTE) and transesophagial echocardiography (TEE) examination within a month. We measured LA and LV dimensions, LV ejection fraction (%EF), wall thickness, E and e′ velocities on TTE, and determined E/e′ ratio. LA appendage thrombus was found in 33 patients (8.1%). Patients with LA thrombus showed lower e′ velocity (5.3±1.8 vs. 7.0±2.2 cm/s, p<.0001) and higher E/e′ ratio (17.2±9.2 vs. 11.5±5.9, p<.0001) than those without it. Using 12.4 as an optimal cutoff point, E/e′ predicted LA thrombus with 70% sensitivity and 70% specificity (AUC=0.72). Odds ratio for LA thrombus in patients in the highest quartile of E/e′ was 6.38 (3.06–13.9). Multivariate logistic regression analysis indicated that the highest quartiles of E/e′ ratio was an independent predictor of LA thrombus among echocardiographic parameters, along with LA dimension and %EF, whereas e′ was not. LA appendage flow velocity was significantly correlated with E/e′ ratio (p<.0001), implying that increased diastolic filling pressure could be associated with impaired blood flow within LA. Increased LV filling pressure increased the risk of LA thrombus in patients with AF, partially through impaired LA hemodynamics. E/e′ ratio on TTE could be useful for detecting high-risk patients for LA thrombus.

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REDUCED LEFT ATRIAL RESERVOIR STRAIN AT REST PREDICTS ELEVATED LEFT VENTRICULAR FILLING PRESSURE DURING EXERCISE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)32045-5 ◽

2019 ◽

Vol 73 (9) ◽

pp. 1439

Author(s):

Katsuji Inoue ◽

Espen Remme ◽

Øyvind Senstad Andersen ◽

Einar Gude ◽

Helge Skulstad ◽

...

Keyword(s):

Left Atrial ◽

Left Ventricular ◽

Filling Pressure ◽

Left Ventricular Filling ◽

Left Ventricular Filling Pressure ◽

Ventricular Filling Pressure ◽

Ventricular Filling

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Left Ventricular Filling Pressure Assessment Using Left Atrial Transit Time by Cardiac Magnetic Resonance Imaging

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.110.959569 ◽

2011 ◽

Vol 4 (2) ◽

pp. 130-138 ◽

Cited By ~ 16

Author(s):

Jie J. Cao ◽

Yi Wang ◽

Jeannette McLaughlin ◽

Elizabeth Haag ◽

Peter Rhee ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Cardiac Magnetic Resonance Imaging ◽

Left Atrial ◽

Left Ventricular ◽

Filling Pressure ◽

Resonance Imaging ◽

Ventricular Filling Pressure ◽

Ventricular Filling

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P1480Left atrial strain improves estimation of left ventricular filling pressure

European Heart Journal ◽

10.1093/eurheartj/ehz748.0245 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

F H Khan ◽

O S Andersen ◽

E Gude ◽

H Skulstad ◽

O A Smiseth ◽

...

Keyword(s):

Left Atrial ◽

Roc Analysis ◽

Right Heart Catheterization ◽

Left Ventricular ◽

Filling Pressure ◽

Left Ventricular Filling Pressure ◽

Heart Catheterization ◽

Right Heart ◽

Ventricular Filling Pressure ◽

Ventricular Filling

Abstract Background The current algorithm in the 2016 recommendations for echocardiographic estimation of left ventricular filling pressure (LVFP) as normal or elevated, combines traditional indices of mitral inflow velocities, tissue Doppler, left atrial volume and tricuspid regurgitation velocity (Figure A). Some of the patients remain unclassified by this algorithm. Left atrial (LA) strain is a novel index that correlates well with LVFP and may improve estimation of LVFP in these patients. Purpose We tested if LA strain can improve estimation of LVFP for the patients that are unclassified by the 2016 algorithm. Methods We analyzed data from 100 patients who were referred to right heart catheterization due to unexplained dyspnea or suspected heart failure. Echocardiography was performed simultaneously with or within 24 hours of right heart catheterization. Pulmonary capillary wedge pressure (PCWP) was used as an estimate for LVFP and defined as elevated if above 12 mmHg. Elevated LVFP was first estimated using the 2016 algorithm. In patients who were unclassified by the algorithm due to conflicting indices or unattainable indices, LA strain was subsequently used to detect elevated LVFP using a cut-off found from ROC analysis of the whole cohort. Results Six patients were unclassified by the 2016 algorithm. The ROC analysis of all 100 patients showed that at an LA strain cut-off of above or below 16.2%, LVFP was correctly classified as normal or elevated, respectively, with a sensitivity of 83% and specificity of 88%. All 6 unclassified patients by the 2016 algorithm were correctly classified using the LA strain cut-off, effectively increasing the accuracy of the algorithm by 6 percentage points. Conclusions LA strain may have a role in non-invasive estimation of LVFP, particularly in patients who remain unclassified when using the conventional echocardiographic indices. Acknowledgement/Funding South-Eastern Norway Regional Health Authority

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