Left atrial strain predicts hemodynamic parameters in cardiovascular patients

Hewing, Bernd; Theres, Lena; Spethmann, Sebastian; Stangl, Karl; Dreger, Henryk; Knebel, Fabian

doi:10.1111/echo.13595

Cited by 36 publications

(27 citation statements)

References 28 publications

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“…Nine of the 18 studies reported LA function with 653 patients (Hozo et al ., ; Rutter & Gatsonis, ; Askenazi et al ., ; Tabata et al ., ; Cameli et al ., ; Rafique et al ., ; Estep et al ., ; Kawasaki et al ., ; Hewing et al ., ), and 50% of them had heart failure (HF). Patients included in these studies were younger compared to those with anatomical LA measurements (63 ± 10 versus 69 ± 10 years, P = 0·001), but there was no difference in LVEF (47·5 ± 10·5 versus 50·3 ± 12·7%, P = 0·67, Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Raised LA pressure, irrespective of its aetiology, causes increased wall stress which leads to chamber dilatation and thinning of the atrial wall (Christensen et al ., ). Myocardial stretch and increase in LA cavity volume is a feature of the response of thin myocardium to pressure overload in contrast to the thick myocardium that gets thicker as is the case in the left ventricle (Hewing et al ., ). Increases in LA volume has also been shown to reflect the duration and severity of raised LA pressure (Hummel et al ., ).…”

Section: Discussionmentioning

confidence: 97%

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Compromised left atrial function and increased size predict raised cavity pressure: a systematic review and meta‐analysis

Bytyçi

Bajraktari²,

Lindqvist

et al. 2019

Clin Physio Funct Imaging

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strain; pulmonary capillary wedge pressure Aim This meta-analysis assesses left atrial (LA) cavity and myocardial function measurements that predict pulmonary capillary wedge pressure (PCWP). Methods PubMed-MEDLINE, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry were searched up to December 2018 for studies on the relationship of LA diameter, LA indexed volume (LAVI max, LAVI min), peak atrial longitudinal (PALS), peak atrial contraction (PACS) strain and total emptying fraction (LAEF) with PCWP. Eighteen studies with 1343 patients were included. Summary sensitivity and specificity (with 95% CI) for evaluation of diagnostic accuracy and the best cut-off values for different LA indices in predicting raised PCWP were estimated using summary receiver operating characteristic analysis. Results The pooled analysis showed association between PCWP and LA diameter: Cohen's d = 0Á87, LAVI max: d = 0Á92 and LAVI min: d = 1Á0 (P<0Á001 for all). A stronger correlation was found between PCWP and PALS: d = 1Á26, and PACS: d = 1Á62, total EF d = 1Á22 (P<0Á0001 for all). PALS ≤19% had a summary sensitivity of 80% (65-90) and summary specificity of 77% (52-92), positive likelihood ratio (LR+) 3Á74, negative likelihood ratio (LR-) <0Á25 and DOR > 15Á1 whereas LAVI ≥34 ml m À2 had summary sensitivity of 75% (55-89) and summary specificity 77% (57-90), with LR+ >3, LR-0Á32 and DOR >10Á1. Conclusions Compromised LA myocardial function and increased size predict raised cavity pressure. These results should assist in optimum follow-up of patients with fluctuating LA pressure.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Compromised left atrial function and increased size predict raised cavity pressure: a systematic review and meta‐analysis

Bytyçi

Bajraktari²,

Lindqvist

et al. 2019

Clin Physio Funct Imaging

View full text Add to dashboard Cite

show abstract

“…A recent meta‐analysis identified E/e' as the most robust parameter within the criteria in determining invasive LV filling pressures, though showing only a modest correlation (r = 0.56) . LA strain has previously shown ability to predict raised resting PCWP in HF with reduced ejection fraction, cardiovascular patients, and heart transplant recipients . Similarly, LA reservoir strain is able to identify patients with elevated resting PCWP > 15 mmHg .…”

Section: Discussionmentioning

confidence: 99%

Impaired left atrial strain predicts abnormal exercise haemodynamics in heart failure with preserved ejection fraction

Telles

Nanayakkara

Evans

et al. 2019

European J of Heart Fail

129

107

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Background Elevated left atrial (LA) pressure, particularly during exercise, is associated with symptomatic status and survival in patients with heart failure with preserved ejection fraction (HFpEF). We aimed to characterize the contribution of abnormal LA mechanical properties to exercise haemodynamics in HFpEF. Methods and results Simultaneous echocardiography and right heart catheterization were performed in 71 subjects with left ventricular ejection fraction ≥ 50% referred for assessment of exertional dyspnoea. According to haemodynamic evaluation, 49 patients were diagnosed with HFpEF [pulmonary capillary wedge pressure (PCWP) ≥ 15 mmHg at rest and/or ≥ 25 mmHg at maximal exertion] and 22 as non‐cardiac dyspnoea. Apical two‐ and four‐chamber views were used for blinded two‐dimensional LA speckle tracking analysis. HFpEF was characterized by impaired LA reservoir (24.3 ± 9.6 vs. 36.7 ± 8.4%, P < 0.001) and pump strain (−11.5 ± 3.2 vs. −17.0 ± 3.4%, P < 0.001); and increased stiffness (0.8 ± 0.7 vs. 0.2 ± 0.1 mmHg/%, P < 0.001). Reservoir and pump strain correlated with exercise PCWP (r = −0.64 and r = 0.72, P < 0.001), and remained independent predictors after adjusting for left ventricular mass index, LA volume index, mean E/e' and systolic blood pressure (B = −0.66 and B = 1.41, respectively, P < 0.001). LA stiffness was strongly related to B‐type natriuretic peptide levels (r = 0.73, P < 0.001; B = 173.0, P < 0.001). Reservoir strain at cut‐off of ≤ 33% predicted invasively verified HFpEF diagnosis with 88% sensitivity and 77% specificity, providing a net reclassification improvement of 12% in comparison to the 2016 European Society of Cardiology criteria for non‐invasive diagnosis of HFpEF. Conclusions Impaired LA reservoir and pump function and increased stiffness are associated with abnormal exercise haemodynamics in HFpEF. These markers provide significant HFpEF diagnostic utility in elderly ambulatory patients with dyspnoea.

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“…Exercise echocardiography should be considered more often because of the higher sensitivity it achieves. Additionally, a number of recent studies have now explored the use of strain echocardiography for characterization of diastolic function . Whether this approach will eventually be superior to Doppler‐based methods remains to be shown.…”

Section: Discussionmentioning

confidence: 99%

Correlation with invasive left ventricular filling pressures and prognostic relevance of the echocardiographic diastolic parameters used in the 2016 ESC heart failure guidelines and in the 2016 ASE/EACVI recommendations: a systematic review in patients with heart failure with preserved ejection fraction

Nauta

Hummel

Meer

et al. 2018

European J of Heart Fail

157

119

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Left atrial strain predicts hemodynamic parameters in cardiovascular patients

Abstract: In a cohort of patients with a broad spectrum of cardiovascular diseases LA strain shows a valuable prediction of hemodynamic parameters, specifically LV filling pressures, in the presence of SR.

Cited by 36 publications

References 28 publications

Compromised left atrial function and increased size predict raised cavity pressure: a systematic review and meta‐analysis

Compromised left atrial function and increased size predict raised cavity pressure: a systematic review and meta‐analysis

Impaired left atrial strain predicts abnormal exercise haemodynamics in heart failure with preserved ejection fraction

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