Left Atrial Strain as a Single Parameter to Predict Left Ventricular Diastolic Dysfunction and Elevated Left Ventricular Filling Pressure in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Borde, Deepak; Joshi, Shreedhar; Jasapara, Amish; Joshi, Pooja; Asegaonkar, Balaji; Apsingekar, Pramod

doi:10.1053/j.jvca.2020.11.066

Cited by 11 publications

(6 citation statements)

References 34 publications

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“…Recently, LA strain has emerged as a parameter that has potential added value in identifying diastolic dysfunction. LASr and LASct are both associated with LV filling pressures [ 33 – 35 ]. Patients with obesity with LAE h2 had significantly lower LASct compared to patients without LAE h2 .…”

Section: Discussionmentioning

confidence: 99%

Improved identification of left atrial enlargement in patients with obesity

Aga,

Acardag,

Chin

et al. 2023

Int J Cardiovasc Imaging

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Accurate standardization of left atrium volume (LAV) in patients with obesity is challenging. The aim of this study was to investigate and to examine the relation between LAV indexed to height2 and left atrial function in patients with moderate to severe obesity. Echocardiograms of patients with moderate to severe obesity (body mass index (BMI) ≥ 35 kg/m2) without known cardiac disease were analyzed. LAV was indexed to body surface area (BSA) and height2, and patients were divided into those with or without left atrial enlargement (LAE) based on normalization using either BSA (LAEbsa) or height2 (LAEh2). Using speckle tracking echocardiography, LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contractile strain (LASct) were assessed as a measure of LA function. LA dysfunction was defined as LASct < 14%. A total of 142 patients were included in the analysis of whom 54.2% had LAEh2 and 18.3% LAEBSA. The LAEh2 group had significantly lower LASct (12.2% ± 3.2% vs. 13.6% ± 4.5%, p = 0.019) as compared to the patients without LAEh2. Significantly more patients with LA dysfunction would be correctly identified by LAEh2 than by LAEBSA (41.5% vs. 15.0%, p < 0.001). In patients with moderate to severe obesity, the use of LAEh2 identified significantly more patients with decreased LA function. LAVh2 should be preferred over LAVBSA in patients with moderate to severe obesity.

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Section: Discussionmentioning

confidence: 99%

Improved identification of left atrial enlargement in patients with obesity

Aga,

Acardag,

Chin

et al. 2023

Int J Cardiovasc Imaging

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“…The association between enlarged LAVI and elevated LV filling pressure is impaired in—among others—athletes, patients with mitral valve disease, patients with atrial fibrillation [ 2 , 33 ], and patients with persistent LA dilatation after heart failure therapy [ 34 ]. While reduced LA strains have been shown to better predict elevated LV filling pressures compared with other single diastolic parameters [ 33 , 35 – 37 ], the diagnostic accuracy of LA strains is nevertheless inferior to that of α .…”

Section: Discussionmentioning

confidence: 99%

MR 4D flow–derived left atrial acceleration factor for differentiating advanced left ventricular diastolic dysfunction

Reiter,

Kräuter

et al. 2023

Eur Radiol

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Objectives The magnetic resonance (MR) 4D flow imaging–derived left atrial (LA) acceleration factor α was recently introduced as a means to non-invasively estimate LA pressure. We aimed to investigate the association of α with the severity of left ventricular (LV) diastolic dysfunction using echocardiography as the reference method. Methods Echocardiographic assessment of LV diastolic function and 3-T cardiac MR 4D flow imaging were prospectively performed in 94 subjects (44 male/50 female; mean age, 62 ± 12 years). LA early diastolic peak outflow velocity (vE), systolic peak inflow velocity (vS), and early diastolic peak inflow velocity (vD) were evaluated from 4D flow data. α was calculated from α = vE / [(vS + vD) / 2]. Mean parameter values were compared by t-test; diagnostic performance of α in predicting diastolic (dys)function was investigated by receiver operating characteristic curve analysis. Results Mean α values were 1.17 ± 0.14, 1.20 ± 0.08, 1.33 ± 0.15, 1.77 ± 0.18, and 2.79 ± 0.69 for grade 0 (n = 51), indeterminate (n = 9), grade I (n = 13), grade II (n = 13), and grade III (n = 8) LV diastolic (dys)function, respectively. α differed between subjects with non-advanced (grade < II) and advanced (grade ≥ II) diastolic dysfunction (1.20 ± 0.15 vs. 2.16 ± 0.66, p < 0.001). The area under the curve (AUC) for detection of advanced diastolic dysfunction was 0.998 (95% CI: 0.958–1.000), yielding sensitivity of 100% (95% CI: 84–100%) and specificity of 99% (95% CI: 93–100%) at cut-off α ≥ 1.58. The AUC for differentiating grade III diastolic dysfunction was also 0.998 (95% CI: 0.976–1.000) at cut-off α ≥ 2.14. Conclusion The 4D flow–derived LA acceleration factor α allows grade II and grade III diastolic dysfunction to be distinguished from non-advanced grades as well as from each other. Clinical relevance statement As a single continuous parameter, the 4D flow–derived LA acceleration factor α shows potential to simplify the multi-parametric imaging algorithm for diagnosis of advanced LV diastolic dysfunction, thereby identifying patients at increased risk for cardiovascular events. Key Points • Detection of advanced diastolic dysfunction is typically performed using a complex, multi-parametric approach. • The 4D flow–derived left atrial acceleration factor α alone allows accurate detection of advanced left ventricular diastolic dysfunction. • As a single continuous parameter, the left atrial acceleration factor α could simplify the diagnosis of advanced diastolic dysfunction.

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“… 3) The reservoir function of the LA as evaluated by volumetric or deformation study is in correlation with the occurrence of postoperative AF, increased in-hospital mortality, elevated LV diastolic pressure, and prolonged lengths of stay in the intensive care unit in patients who undergo CABG. 14) 15) 34) 35) The conduit function of the LA correlates with postoperative AF and longer stays in the intensive care unit in the aforementioned population. 35) The ability of LA contraction function to predict postoperative AF has yet to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

Determinants of the Volumetric Markers of Left Atrial Contraction Function in Coronary Artery Disease: A Cross-sectional Study

Etemad

Hosseinsabet

Omidi

et al. 2022

J Cardiovasc Imaging

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BACKGROUND A body of research advocates the prognostic role and usefulness of the volumetric markers of left atrial (LA) phasic functions in the diagnosis of LA dysfunction. We aimed to determine the independent determinants of the volumetric markers of LA contraction function in candidates for coronary artery bypass graft (CABG) surgery. METHODS This cross-sectional study enrolled 516 candidates for CABG. The biplane maximal, minimal, and pre-P volumes of the LA were measured with two-dimensional echocardiography, and LA active emptying fraction was calculated. The standardized correlation coefficient for the correlation between each factor and LA active emptying fraction was calculated by using univariate and backward multivariable regression analyses. RESULTS The multivariable regression analysis demonstrated that the heart rate (β = 0.15; p = 0.001), S (β = 0.09; p = 0.036), E/e′ ratio (β = −0.11; p = 0.014), left ventricle (LV) ejection fraction (β = 0.15; p = 0.001), and LA enlargement (β = −0.19; p < 0.001) were the independent determinants of LA active emptying fraction. CONCLUSIONS The independent determinants of LA contraction function were the heart rate, S, LV ejection fraction, LA enlargement, and E/e′ ratio in candidates for CABG surgery.

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Left Atrial Strain as a Single Parameter to Predict Left Ventricular Diastolic Dysfunction and Elevated Left Ventricular Filling Pressure in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Cited by 11 publications

References 34 publications

Improved identification of left atrial enlargement in patients with obesity

Improved identification of left atrial enlargement in patients with obesity

MR 4D flow–derived left atrial acceleration factor for differentiating advanced left ventricular diastolic dysfunction

Determinants of the Volumetric Markers of Left Atrial Contraction Function in Coronary Artery Disease: A Cross-sectional Study

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