Left atrial strain rate during atrial contraction predicts raised pulmonary capillary wedge pressure: evidence for left atrio-ventricular interaction

Lindqvist, Per; Henein, Michael Y.

doi:10.1007/s10554-020-02126-7

Cited by 15 publications

(14 citation statements)

References 31 publications

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“…Our study also confirms significant impairment of the reservoir function, with similar conduit function in HFpEF compared to preHF group. Of note all LA strain and strain rate parameters had very good reproducibility in our study, similar to the most recent publications [ 33 , 34 ].…”

Section: Discussionsupporting

confidence: 91%

“…Lindqvist et al [ 34 ], in a recent publication, demonstrated using invasive evaluation of the LA pressure, that SR_CT was the best accurate component of LA deformation measurements that correlated with PCWP. This parameter had superior accuracy in predicting elevated PCWP compared to recently proposed uni- and multivariable-based algorithms (r 2 = 0.60, p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

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New insights into the potential utility of the left atrial function analysis in heart failure with preserved ejection fraction diagnosis

et al. 2022

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Aims None of the conventional echocardiographic parameters alone predict increased NTproBNP level and symptoms, making diagnosis of heart failure with preserved ejection fraction (HFpEF) very difficult in some cases, in resting condition. We evaluated LA functions by 2D speckle tracking echocardiography (STE) on top of conventional parameters in HFpEF and preHF patients with diastolic dysfunction (DD), in order to establish the added value of the LA deformation parameters in the diagnosis of HFpEF. Methods We prospectively enrolled 125 patients, 88 with HFpEF (68±9 yrs), and 37 asymptomatic with similar risk factors with DD (preHF) (61±8 yrs). We evaluated them by NTproBNP, conventional DD parameters, and STE. Global longitudinal strain (GS) was added. LA reservoir (R), conduit (C), and pump function (CT) were assessed both by volumetric and STE. 2 reservoir strain (S) derived indices were also measured, stiffness (SI) and distensibility index (DI). Results LA R and CT functions were significantly reduced in HFpEF compared to preHF group (all p<0.001), whereas conduit was similarly in both groups. SI was increased, whereas DI was reduced in HFpEF group (p<0.001). By adding LA strain analysis, from all echocardiographic parameters, SR_CT<-1.66/s and DI<0.57 (AUC = 0.76, p<0.001) demonstrated the highest accuracy to identify HFpEF diagnosis. However, by multivariate logistic regression, the model that best identifies HFpEF included only SR_CT, GS and sPAP (R2 = 0.506, p<0.001). Moreover, SR_CT, DI, and sPAP registered significant correlation with NTproBNP level. Conclusions By adding LA functional analysis, we might improve the HFpEF diagnosis accuracy, compared to present guidelines. LA pump function is the only one able to differentiates preHF from HFpEF patients at rest. A value of SR_CT < -1.66/s outperformed conventional parameters from the scoring system, reservoir strain, and LA overload indices in HFpEF diagnosis. We suggest that LA function by STE could be incorporated in the current protocol for HFpEF diagnosis at rest as a major functional criterion, in order to improve diagnostic algorithm, and also in the follow-up of patients with risk factors and DD, as a prognostic marker. Future studies are needed to validate our findings.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

New insights into the potential utility of the left atrial function analysis in heart failure with preserved ejection fraction diagnosis

et al. 2022

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“…Left atrial strain (LAS) analysis by speckle tracking echocardiography (STE) is a relatively new method for evaluating LA function [4][5][6]. Some reports have highlighted the role of LAS in predicting the recurrence of AF after ablation [7] and a relationship between LAS values and invasively estimated left atrial pressure (LAP) values [8,9]. High LAP has proven to be an independent predictor of symptomatic AF recurrence after catheter ablation and has been associated with advanced LA remodeling [10].…”

Section: Introductionmentioning

confidence: 99%

Correlations between left atrial strain and left atrial pressures values in patients undergoing atrial fibrillation ablation

et al. 2021

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Background:We aimed to investigate the correlations between left atrial strain (LAS) assessed by speckle tracking echocardiography and directly measured left atrial pressures (LAP) values and to estimate the features of patients with lower LAS values. Methods:A prospective, observational study was performed on patients with atrial fibrillation (AF) undergoing ablation. Detailed transthoracic echocardiography with the speckle tracking method was used to estimate the LAS reservoir (LASr) and direct measurements of LAP during ablation in all patients.Results: A total of 172 patients were included (98 with sinus rhythm [SR] and 74 with AF). The patients with lower LASr (first tercile) compared to those with higher (third tercile), were older, more often female, presented with a larger left atrium (LA) (per the LA area and volume index), and had more impaired left ventricular (LV) diastolic function parameters (e' , E/e'). The correlation analysis of the echocardiographic parameters with the LAP revealed the most significant correlations in the SR group, where the E/e' ratio, LASr, and LAS contraction (LASct) values were all associated with LAP. The cut-off value of LASr estimating high elevated mean LAP (≥15 mm Hg) was 21.88 (Area Under Curve [AUC], 0.81; 95% confidence interval [CI], 0.72-0.90; P <0.0001) for the SR group and 11.25 (AUC, 0.66; 95% CI, 0.53-0.80; P = 0.016) for the AF group.Conclusions: AF patients with lower LASr are older, more often female, have a larger LA, and have more impaired LV diastolic function. Low LASr and LASct and high E/e' ratio values are associated with higher LAP in AF patients with SR.

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“…The load alteration during CPAP interventions has been shown to be associated with a small change in LV GLS with simultaneous change in LAS during the same cardiac cycle [ 14 ]. Our findings confirm this interaction (Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

Left atrial contraction strain and controlled preload alterations, a study in healthy individuals

Gottfridsson

Aroch

Lindqvist

et al. 2022

Cardiovasc Ultrasound

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Background In order to assess left atrial contractile function in disturbed circulatory conditions, it is necessary to have a clear understanding of how it behaves in a normal resting state with changes in loading conditions. However, currently the understanding of this relationship is incomplete. We hypothesize that in healthy individuals, left atrial contraction strain and its peak strain rate are increased or decreased by increasing or decreasing preload, respectively. Methods Controlled maneuvers used to change preload included continuous positive airway pressure by mask (CPAP 20 cmH2O) for preload decrease, and passive leg raise (15 degrees angle) for preload increase. Cardiac ultrasound 4-chamber views of the left atria and left ventricle were acquired at baseline and during maneuver. Acquired images were post processed and analyzed offline. Comparisons were made using paired t-test and means with 95% confidence interval. Results There were 38 participants, complete results were obtained from 23 in the CPAP maneuver and 27 in the passive leg raise maneuver. For the CPAP group, left atrial contraction strain was 11.6% (10.1 to 13.1) at baseline and 12.8% (11.0 to 14.6) during the maneuver (p = 0.16). Left atrial contraction peak strain rate was − 1.7 s− 1 (− 1.8 to − 1.5) at baseline and − 1.8 s− 1 (− 2.0 to − 1.6) during the maneuver (p = 0.29). For the passive leg raise-group, left atrial contraction strain was 10.1% (9.0 to 11.2) at baseline and 10.8% (9.4 to 12.3) during the maneuver (p = 0.28). Left atrial contraction peak strain rate was − 1.5 s− 1 (− 1.6 to − 1.4) at baseline and − 1.6 s− 1 (− 1.8 to − 1.5) during the maneuver (p = 0.29). Left atrial area, an indicator of preload, increased significantly during passive leg raise and decreased during CPAP. Conclusion In healthy individuals, left atrial contraction strain and its peak strain rate seem to be preload-independent. Trial registration The study was 2018-02-19 registered at clinicaltrials.gov (NCT03436030).

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Left atrial strain rate during atrial contraction predicts raised pulmonary capillary wedge pressure: evidence for left atrio-ventricular interaction

Cited by 15 publications

References 31 publications

New insights into the potential utility of the left atrial function analysis in heart failure with preserved ejection fraction diagnosis

New insights into the potential utility of the left atrial function analysis in heart failure with preserved ejection fraction diagnosis

Correlations between left atrial strain and left atrial pressures values in patients undergoing atrial fibrillation ablation

Left atrial contraction strain and controlled preload alterations, a study in healthy individuals

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