Left Atrial Strain as a Predictor of Diastolic Stress Test Results in Patients With Arterial Hypertension

Мазур, Е. С.; Мазур, В. В.; Bazhenov, N. D.; Нилова, О.В.; Nikolaeva, Tatiana O.

doi:10.18087/cardio.2022.9.n2206

Cited by 2 publications

(1 citation statement)

References 23 publications

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“…Критерии включения: ДД со снижением ранней диастолической скорости движения фиброзного кольца митрального клапана, оцененной при помощи тканевой допплерографии (Tissue Doppler Imaging, TDI); недостаточное количество критериев для заключения о повышенном ДЗ ЛЖ по данным традиционной ЭхоКГ покоя (отсутствие 2-х либо 3-х положительных критериев из 3-х возможных). Учитывали отношение Е/е' (отношение ранней диасто- шении анализа фазовой деформации ЛП, который может получить более широкое распространение [3,4,16,17]. Неспособность миокарда ЛЖ к адекватному растяжению и прогрессирующее увеличение ДЗ ЛЖ в раннюю диастолу описывается ростом отношения E/e'; угнетение растяжения стенок ЛП в резервуарную фазу/увеличение среднего давления в ЛП выражается снижением LASr [3].…”

Section: материал и методыunclassified

Left atrial stiffness index in the identification of heart failure with preserved ejection fraction

Shirokov,

Yaroslavskaya,

Kosterin

et al. 2024

Cardiovasc Ther Prev

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Aim. To study the diagnostic value of the left atrial stiffness index (LASI) of heart failure with preserved ejection fraction (HFpEF) depending assessed by transthoracic echocardiography (TTE) in the diagnosis on diastolic stress test (DST) results.Material and methods. DST was performed in cases of insufficient criteria for increased left ventricular filling pressure assessed by TTE. One hundred patients were examined (52,0% men, 66,1±5,4 years). Patients with a ratio of early transmitral flow velocity to early diastolic mitral annulus velocity (E/e') ratio >15 in DST were included in group I (n=45), patients with E/e' <15 — group II (n=55). The speckle tracking echocardiography was used to assess left atrial reservoir strain (LASr).Results. Significant differences were identified between the groups in sex (40,0% of men in group I and 61,8% in group II, respectively; p=0,044), body mass index (32,9 [29,5;36,0] and 29,6 [27,3;31,8] kg/m2; p=0,001), hypertension stage (2,9±0,3 and 2,5±0,8, p=0,037), the presence of coronary artery disease (88,9 and 67,3%; p=0,016), NYHA heart failure class (2,0±0,4 and 1,5±0,7; p=0,003). TTE revealed significant differences in the left atrium volume index (31,9 [28,5;36,0] and 27,8 [24,1;34,6] ml/m2; p=0,039), E/e' ratio (10,9 [9,7;12,5] and 9,3 [7,4;10,8]; p<0,001), LASr (23,5 [19,3;28,3] and 28,9 [25,6;32,2]%, p<0,001) and LASI (0,46 [0,38;0,56] and 0,30 [0,25;0,39]; p<0,001). According to ROC analysis, the largest area under the curve (AUC), optimal sensitivity and specificity in HFpEF diagnosis were observed in LASI (AUC=0,829, p<0,001; 77,8 and 74,5%, respectively). Lower classification quality was shown by the H2FPEF score (AUC=0,701, p=0,001; 66,7 and 69,1%), while the HFA-PEFF score was not significant in the pretest detection of HFpEF (AUC=0,608, p=0,065; 53,3 and 61,8%).Conclusion. LASI with a cut-off point >0,38 has the greatest ability to detect HFpEF among the possible pretest diagnostic methods.

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Section: материал и методыunclassified

Left atrial stiffness index in the identification of heart failure with preserved ejection fraction

Shirokov,

Yaroslavskaya,

Kosterin

et al. 2024

Cardiovasc Ther Prev

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An Increase in the Left Atrium Volume During Exercise is Associated With a Positive Result of a Diastolic Stress Test in Patients With Arterial Hypertension

Mazur,

Bazhenov

et al. 2024

Kardiologiia

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Aim. To study the relationship between changes in left atrial volume (LAV) during exercise and the result of a diastolic stress test (DST) in patients with arterial hypertension (AH).Material and methods. The study included 219 patients with AH without ischemic heart disease and atrial fibrillation. During the DST performed before and after exercise, the ratio of transmitral flow velocity to mitral annular velocity (E/e’), the left atrial global longitudinal strain in the reservoir phase (reservoir strain), and LAV were determined. The criterion for a positive DST was an increase in E/e′ ≥15.Results. A positive result of DST was observed in 90 (41.1%) patients. Patients with positive DST were older (65.0 and 59.0 years); among them, there were fewer men (24.4 and 41.1%), but more patients with obesity (66.7 and 40.3%) and diabetes mellitus (36.7 and 8.5%). At rest, patients with positive DST had higher E/e' ratio (11.5 and 8.8), pulmonary artery systolic pressure (29.0 and 27.0 mm Hg), and LAV (60.0 and 52.0 ml), but a lower left atrial reservoir strain (20.0 and 24.0%). During exercise in patients with positive and negative DST, E/e’ increased by 5.46 and 0.47 units, respectively. Changes in the LAV and reservoir strain during exercise in these groups were directed differently. In patients with positive DST, the left atrial reservoir strain decreased by 1.0 percentage points (pp) whereas in patients with negative DST, it increased by 8.0 pp. During exercise, the LAV increased by 10.0 ml in patients with a positive DST, whereas in the alternative group, the LAV decreased by 8.5 ml. The AUC for changes in LAV as an indicator of a positive DST was 0.987 while the AUC for the resting left atrial reservoir strain was 0.938. An increase in LAV >1 ml, as an indicator of a positive DST has a sensitivity of 96.9% and a specificity of 95.1%.Conclusion. In AH patients, changes in left ventricular filling pressure are associated with a unidirectional change in LAV. An increase in LAV during exercise by more than 1 ml can serve as a criterion for a positive DST result. This assessment was consistent with the assessment of the DST result by the E/e’ criterion >15 in 94.5% of cases.

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Left Atrial Strain as a Predictor of Diastolic Stress Test Results in Patients With Arterial Hypertension

Cited by 2 publications

References 23 publications

Left atrial stiffness index in the identification of heart failure with preserved ejection fraction

Left atrial stiffness index in the identification of heart failure with preserved ejection fraction

An Increase in the Left Atrium Volume During Exercise is Associated With a Positive Result of a Diastolic Stress Test in Patients With Arterial Hypertension

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