Functional and Anatomic Responses of the Left Atrium to Change in Estimated Left Ventricular Filling Pressure

Huynh, Quan; Kalam, Kashif; Iannaccone, Andrea; Negishi, Kazuaki; Thomas, Liza; Marwick, Thomas H.

doi:10.1016/j.echo.2015.07.028

Cited by 52 publications

(34 citation statements)

References 33 publications

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“…It has been proposed that peak LA strain provides incremental insight beyond typical measures of remodeling, namely LA enlargement, a finding which in itself accompanies a number of cardiovascular diseases [9, 14]. Indeed, our results support this notion, as LAVi > 34 mL/m 2 was able to identify subjects with elevated LV filling pressures, but at the cost of a higher false positive rate compared to peak LA strain (Fig.…”

Section: Discussionsupporting

confidence: 76%

Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures

Singh

Medvedofsky

Mediratta

et al. 2018

Int J Cardiovasc Imaging

128

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Echocardiographic assessment of left ventricular (LV) filling pressures is performed using a multi-parametric algorithm. Left atrial (LA) strain was recently found to accurately classify the degree of diastolic dysfunction. We hypothesized that LA strain could be used as a stand-alone marker and sought to identify and test a cutoff, which would accurately detect elevated LV pressures. We studied 76 patients with a spectrum of LV function who underwent same-day echocardiogram and invasive left-heart catheterization. Speckle tracking was used to measure peak LA strain. The protocol involved a retrospective derivation group (N = 26) and an independent prospective validation cohort (N = 50) to derive and then test a peak LA strain cutoff which would identify pre-A-wave LV diastolic pressure > 15 mmHg. The guidelines-based assessment of filling pressures and peak LA strain were compared side-by-side against invasive hemodynamic data. In the derivation cohort, receiver-operating characteristic analysis showed area under curve of 0.76 and a peak LA strain cutoff < 20% was identified as optimal to detect elevated filling pressure. In the validation cohort, peak LA strain demonstrated better agreement with the invasive reference (81%) than the guidelines algorithm (72%). The improvement in classification using LA strain compared to the guidelines was more pronounced in subjects with normal LV function (91% versus 81%). In summary, the use of a peak LA strain to estimate elevated LV filling pressures is more accurate than the current guidelines. Incorporation of LA strain into the non-invasive assessment of LV diastolic function may improve the detection of elevated filling pressures.

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Section: Discussionsupporting

confidence: 76%

Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures

Singh

Medvedofsky

Mediratta

et al. 2018

Int J Cardiovasc Imaging

128

View full text Add to dashboard Cite

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“…However, LAVI is a better marker of chronic elevation in LV filling pressures and does not reflect acute pressure changes; in contrast, LA strain may provide incremental information on LA function in addition to dynamic changes in LV filling pressures and may further contribute to the assessment of diastolic function (Fig. ) . Importantly, the use of TR velocity to detect diastolic dysfunction may be limited in patients with ESLD.…”

Section: Redefining Ccm Criteria: Alignment With Contemporary Metricsmentioning

confidence: 99%

“…4). (29,30) Importantly, the use of TR velocity to detect diastolic dysfunction may be limited in patients with ESLD. Because TR velocity is marker of pulmonary hypertension but cannot distinguish pulmonary venous (postcapillary) from pulmonary arterial hypertension (precapillary), it may be elevated in conditions that cause precapillary hypertension, including portopulmonary hypertension, in the absence of elevated LV filling pressures due to diastolic dysfunction.…”

Section: Diastolic Functionmentioning

confidence: 99%

Redefining Cirrhotic Cardiomyopathy for the Modern Era

et al. 2019

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Cirrhotic cardiomyopathy (CCM) is cardiac dysfunction in patients with end‐stage liver disease in the absence of prior heart disease. First defined in 2005 during the World Congress of Gastroenterology, CCM criteria consisted of echocardiographic parameters to identify subclinical cardiac dysfunction in the absence of overt structural abnormalities. Significant advancements in cardiovascular imaging over the past 14 years, including the integration of myocardial deformation imaging into routine clinical practice to identify subclinical cardiovascular dysfunction, have rendered the 2005 CCM criteria obsolete. Therefore, new criteria based on contemporary cardiovascular imaging parameters are needed. In this guidance document, assembled by a group of multidisciplinary experts in the field, new core criteria based on contemporary cardiovascular imaging parameters are proposed for the assessment of CCM. This document provides a critical assessment of the diagnosis of CCM and ongoing assessment aimed at improving clinical outcomes, particularly surrounding liver transplantation. Key points and practice‐based recommendations for the diagnosis of CCM are provided to offer guidance for clinicians and identify gaps in knowledge for future investigations.

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“…Once dilated, LA volume will reduce but rarely normalize with decreased LV filling pressures, suggesting irreversible remodeling. 9 Although, the impact of diastolic dysfunction on LA function has more recently been described, it is less broadly known. Mechanistically, both LA compliance and contraction can be incrementally affected by elevated LV filling pressures in the setting of worsening diastolic dysfunction.…”

Section: See Article By Freed Et Almentioning

confidence: 99%

“…12,13 LA longitudinal strain data have been demonstrated to improve with reduced LV filling pressures, thereby also showing a potential target for therapeutic and disease monitoring. 9 Despite these advances in the understanding of LA mechanics and HFpEF with LA strain, the impact on outcomes remains unknown. As such, LA strain has never been incorporated into regular clinical practice or guideline algorithms for identification and classification of HFpEF.…”

Section: See Article By Freed Et Almentioning

confidence: 99%