Correlation of left atrial strain with left ventricular end-diastolic pressure in patients with normal left ventricular ejection fraction

Fan, Jiali; Su, Bo; Zhao, Xin; Zhou, Baoyuan; Ma, Changsheng; Wang, Haipeng; Hu, Shengda; Zhou, Yafeng; Ju, Yi-Jiao; Wang, Minghan

doi:10.1007/s10554-020-01869-7

Cited by 40 publications

(39 citation statements)

References 23 publications

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“…Non-invasive imaging modalities have assessed LA deformation for initial diagnosis [25,[44][45][46][47], prognostic assessment [48-51], and evaluation of treatment response across different disease states [52][53][54][55]. Cardiac deformation analysis using strain and strain rate (SR) imaging allows early detection of pre-clinical cardiac disease.…”

Section: La Deformation Assessmentmentioning

confidence: 99%

Multi-modality assessment and role of left atrial function as an imaging biomarker in cardiovascular disease

Alfuhied

Kanagala

McCann

et al. 2021

Int J Cardiovasc Imaging

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The left atrium (LA) plays a vital role in maintaining normal cardiac function. LA volume and function have been utilised as important imaging biomarkers, with their prognostic value demonstrated in multiple cardiac conditions. More recently, there has been a sharp increase in the number of publications utilising LA strain by echocardiography and cardiac magnetic resonance (CMR) imaging. However, little is known about its prognostic value or reproducibility as a technique. In this review, we aim to highlight the conventional and novel imaging techniques available for LA assessment, using echocardiography and CMR, their role as an imaging biomarker in cardiovascular disease, the reproducibility of the techniques and the current limitations to their clinical application. We identify a need for further standardisation of techniques, with establishment of ‘normal’ cut-offs before routine clinical application can be made.

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Section: La Deformation Assessmentmentioning

confidence: 99%

Multi-modality assessment and role of left atrial function as an imaging biomarker in cardiovascular disease

Alfuhied

Kanagala

McCann

et al. 2021

Int J Cardiovasc Imaging

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“…Recently, LA function measured as LA reservoir strain (LASr) has been shown to be significantly related to invasive left ventricular filling pressure [ 5 , 6 , 11 ]. This was also confirmed in our study [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that left atrial (LA) strain, especially LA strain during the reservoir phase (LASr), is impaired in the setting of LV diastolic dysfunction and correlates well with LVFP or pulmonary capillary wedge pressure, suggesting that LASr is clinically useful for estimating LVFP [ 5 , 6 ]. However, in some patients with coronary artery disease, LASr is not the best parameter for discriminating the filling pressure status [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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

Zhou

Zhao

Shen

et al. 2021

Cardiovasc Ultrasound

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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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“…All images were stored digitally, volume and strain analyses were performed offline using a commercially available software (QLab 10.8.0; Philip Healthcare). The LA maximum and minimum volume indices (LAVImax and LAVImin, respectively) and LA empty fraction (LAEF) were evaluated from the apical 4-and 2-chamber views by the 2-dimensional quantitative speckletracking method [11,15,16]. All images were analyzed by 2 investigators who were blinded to participants' characteristics and exercise performance.…”

Section: Echocardiographymentioning

confidence: 99%

“…However, evaluating LA phasic function by strain analysis was recently shown to be feasible and reproducible, with alterations in LA strain preceding changes in LA volume. There is evidence that LA reservoir strain combined with the ratio of transmitral E velocity to tissue Doppler mitral annulus e′ velocity (E/e′) is a useful single measure for predicting elevated LV filling pressure reflecting LV function in patients with coronary artery disease [11]. Although various LA parameters have been proposed, there is no single parameter that best defines LA function in CHF patients with reduce exercise capacity.…”

Section: Introductionmentioning

confidence: 99%

Left Atrial Reservoir Longitudinal Strain is a Resting Marker of Exercise Capacity in Chronic Heart Failure: A Cross-sectional Study

Sun

Cen

Chen

et al. 2021

Preprint

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Background: Left atrial (LA) function is an important parameter for assessing left ventricular performance. This study investigated the relationship between LA function as determined by strain analysis and exercise capacity in patients with chronic heart failure (CHF). Methods: A total of 51 patients with CHF were prospectively recruited from the Baduanjin-eight-silken-movement With Self-efficacy Building for Patients With Chronic Heart Failure study. Resting echocardiographic parameters including the ratio of transmitral E velocity to tissue Doppler mitral annulus e′ velocity (E/e′), minimum left atrial volume index (LAVI min ), maximum left atrial volume index (LAVI max ), and left atrial empty fraction (LAEF) as well as global phasic longitudinal strain (reservoir strain [LALSr], conduit strain [LALScd], and contractile strain [LALSct]) were measured and compared with maximum oxygen uptake (VO 2max ) in terms of performance in predicting reduced exercise capacity. Results: Mean age of study patients was 60.18 ± 10.41 years, mean left ventricular ejection fraction was 32.8 ± 14.2%, and mean VO 2max was 17.02 ± 4.64 mL/kg/min. Eleven (21.57%) patients were women, and 32 (62.75%) had coranary heart disease. Univariate linear regression analysis identified age and N-terminal prohormone of brain natriuretic peptide level as independent clinical parameters associated with VO 2max (both P<0.05); independent resting echocardiographic parameters included LALSRr (P<0.001); average late diastolic velocity of septal and lateral wall annulus, LAVI max , LAVI min , LALSRr, LALSRct, and LAEF (all P<0.01); and E and E/e′ (both P<0.05). The multivariate linear regression analysis revealed 4 independent clinical predictors of VO 2max including (β = 0.351; P = 0.007), age (β = -0.271; P = 0.027), body mass index (β = -0.260; P = 0.032) and N-terminal prohormone of brain natriuretic peptide (β = -0.257; P = 0.041). Conclusions: LALSr is a marker of decreased LA compliance and an independent correlate of VO 2max with high diagnostic value in patients with CHF. Thus, LALSr can be used for risk stratification of CHF patients with reduced exercise capacity and poor cardiovascular outcome. Trial registration: NCT03180320 (ClinicalTrials.gov). Registered 8 June 2017, https://clinicaltrials.gov/ct2/show/NCT03180320?term=Baduanjin-eight-silken-movement&draw=2&rank=1.

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Correlation of left atrial strain with left ventricular end-diastolic pressure in patients with normal left ventricular ejection fraction

Cited by 40 publications

References 23 publications

Multi-modality assessment and role of left atrial function as an imaging biomarker in cardiovascular disease

Multi-modality assessment and role of left atrial function as an imaging biomarker in cardiovascular disease

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

Left Atrial Reservoir Longitudinal Strain is a Resting Marker of Exercise Capacity in Chronic Heart Failure: A Cross-sectional Study

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