Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study

Sugimoto, Tadafumi; Robinet, Sébastien; Dulgheru, Raluca; Bernard, Anne; Ilardi, Federica; Contu, Laura; Addetia, Karima; Caballero, Luis; Athanassopoulos, George; Baroni, Monica; Cardim, Nuno; Hagendorff, Andreas; Hristová, Krasimira; López, Teresa; Morena, Gonzalo de la; Popescu, Bogdan A; Pěnička, Martin; Özyiğit, Tolga; Carbonero, D. Rodrigo; Veire, Nico Van de; Bardeleben, Ralph Stephan von; Vinereanu, Dragoş; Zamorano, José Luís; Marchetta, Stella; Nchimi, Alain; Roşca, Monica; Călin, Andreea; Moonen, Marie; Cimino, Sara; Magné, Julien; Cosyns, Bernard; Galli, Elena; Donal, Erwan; Habib, Gilbert; Esposito, Roberta; Galderisi, Maurizio; Badano, Luigi P.; Lang, Roberto M.; Lancellotti, Patrizio; Kou, Seisyou; Go, Yun Yun; Barone, Daniele; Diego, José Juan Gómez de; Kacharava, George; Gonjilashvili, Natalia; Курашвили, Л. В.; Akhaladze, Natela; Mgaloblishvili, Zaza; Oliva, María J.; González-Carrillo, Josefa; Rimbaş, Roxana Cristina; Ciobanu, A.; Peluso, Diletta; Jose, Seena Padayattil; Sutter, Johan De; Kotrč, Martin; Voigt, Jens‐Uwe; Salustri, Alessandro

doi:10.1093/ehjci/jey018

Cited by 168 publications

(125 citation statements)

References 24 publications

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“…A sensitivity analysis demonstrated no difference in diagnostic performance for LA strain and LA compliance when stratified by time difference between the echocardiogram and catheterization either at 24 or 48 h ( Table ). There is no established cut‐point defining abnormal LA reservoir strain for diagnostic purposes, and the value observed to provide optimal discrimination in this study may not apply in others. Although bootstrap validation supported the optimal cut‐point of 24.5%, further study is required to determine whether the cut‐point derived from the current data effectively discriminates HFpEF from NCD in other cohorts.…”

Section: Discussionmentioning

confidence: 86%

Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction

Reddy

Obokata

Egbe

et al. 2019

European J of Heart Fail

176

170

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Aims Left atrial (LA) function is impaired in heart failure with preserved ejection fraction (HFpEF) and predicts disease severity and risk of adverse outcome. We sought to evaluate whether LA strain could enhance diagnosis of HFpEF. Methods and results Consecutive patients with unexplained exertional dyspnoea and image quality suitable for measuring LA strain underwent invasive cardiopulmonary exercise testing to ascertain the presence of HFpEF or non‐cardiac causes of dyspnoea (NCD). LA reservoir strain was measured in all patients, while LA conduit and booster strain were measured in patients with sinus rhythm. LA strain was measurable in 363 of 378 examinations (96.5%; HFpEF: 238, NCD: 125). LA reservoir strain (29 ± 16% vs. 40 ± 13%, P < 0.0001) and conduit strain (18 ± 10% vs. 22 ± 10%, P = 0.0001) were significantly impaired in HFpEF compared to NCD. Of all echocardiographic indices, LA reservoir strain best discriminated HFpEF from NCD [area under the curve (AUC) 0.719, P < 0.0001], outperforming E/e' (AUC difference +0.117, P < 0.0001), LA enlargement (+0.090, P = 0.001), tricuspid regurgitation velocity > 2.8 m/s (+0.082, P = 0.0085), left ventricular hypertrophy (+0.0159, P < 0.0001) and left ventricular global longitudinal strain (+0.0198, P < 0.0001). Indexing LA reservoir strain to estimated LA pressure (E/e') as a surrogate for LA compliance further improved diagnostic performance (AUC 0.772, P < 0.0001; +0.053 compared to LA reservoir strain alone, P = 0.003). Conclusion Left atrial reservoir strain may provide enhanced diagnostic accuracy beyond conventional echocardiographic measures to discriminate HFpEF from NCD. Further study is required to verify the diagnostic utility of LA strain.

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Section: Discussionmentioning

confidence: 86%

Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction

Reddy

Obokata

Egbe

et al. 2019

European J of Heart Fail

176

170

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“…Based on the results of the NORRE study on the echocardiographic reference ranges for normal left atrial function parameters in a cohort of 371 healthy people (mean of lower limit of normality for LAS in the whole study population 26.1 ± 0.7%; 27.7 ± 1.5% for age 40-60 years old; 22.7 ± 2.0% for age ≥60 years old), and after calculating the mean of the lower limit of normality for the 95% confidential interval, we conducted an additional analysis dividing our study patients in three groups by using a LA strain cut-off of 20% and 28%. 19 We assumed a LA strain <20% to be pathological, LA strain 20-28% to be a grey zone, and LA strain >28% to be normal. The diagnostic performance of LA strain to determine a severe DD (defined as mitral E/A ratio ≥2 according to the 2016 ASE/EACVI criteria) was analysed by means of the area under the curve (AUC) of receiver operating characteristic curve analysis.…”

Section: Discussionmentioning

confidence: 99%

“…An abnormal LA strain was defined as ≤23%, based on published data regarding the lower limit of normality. 5,[17][18][19] . LA maximal volume was measured at the end-systole when the left atrium had its maximum volume and LA minimal volume was measured at the end-diastole, when the left atrium had its minimum volume.…”

Section: Echocardiographic Analysismentioning

confidence: 99%

Left atrial strain as sensitive marker of left ventricular diastolic dysfunction in heart failure

et al. 2020

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Aims The purpose of this retrospective analysis was to examine the association of left atrial (LA) strain (i.e. LA reservoir function) with left ventricular diastolic dysfunction (DD) in patients with heart failure with reduced and preserved left ventricular ejection fraction (LVEF). Methods and results We analysed the baseline echocardiographic recordings of 300 patients in sinus rhythm from the SOCRATES-PRESERVED and SOCRATES-REDUCED studies. LA volume index was normal in 89 (29.7%), of whom 60.6% had an abnormal LA reservoir strain (i.e. ≤23%). In addition, the extent of LA strain impairment was significantly associated with the severity of DD according to the 2016 American Society of Echocardiography recommendations (DD grade I: LA strain 22.2 ± 6.6, rate of abnormal LA strain 62.9%; DD grade II: LA strain 16.6 ± 7.4, rate of abnormal LA strain 88.6%; DD grade III: LA strain 11.1 ± 5.4%, rate of abnormal LA strain 95.7%; all P < 0.01). In line with these findings, LA strain had a good diagnostic performance to determine severe DD [area under the curve 0.83 (95% CI 0.77-0.88), cutoff 14.1%, sensitivity 80%, specificity 77.8%], which was significantly better than for LA volume index, LA total emptying fraction, and the mitral E/e′ ratio. Conclusions The findings of this analysis suggest that LA strain could be a useful parameter in the evaluation of DD in patients with heart failure and sinus rhythm, irrespective of LVEF.

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“…Even if LA volumes were similar between HFpEF and NCD in this study, LA function was markedly impaired as assessed by strain parameters, with incremental diagnostic value beyond current guidelines . LA reservoir strain ≤ 33% could identify HFpEF with reasonably high sensitivity (82%), but the cut‐off used by the authors is based on previous reports of risk stratification and normal distribution, but not on diagnosis, and it seems to fall within normal range according to a recent European multicentre study (the lowest limits of normality: 26.1%) …”

Section: Fundingmentioning

confidence: 55%

Left atrial dysfunction: the next key target in heart failure with preserved ejection fraction

Obokata

Borlaug

2019

European J of Heart Fail

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Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study

Abstract: The NORRE study provides contemporary, applicable echocardiographic reference ranges for LA function. Our data highlight the importance of age-specific reference values for LA functions.

Cited by 168 publications

References 24 publications

Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction

Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction

Left atrial strain as sensitive marker of left ventricular diastolic dysfunction in heart failure

Left atrial dysfunction: the next key target in heart failure with preserved ejection fraction

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