Mitral early-diastolic inflow peak velocity (E)-to-left atrial strain ratio as a novel index for predicting elevated left ventricular filling pressures in patients with preserved left ventricular ejection fraction

Zhou, You; Zhao, Chen; Shen, Zhenya; Zhao, Xin; Zhou, Baoyuan

doi:10.1186/s12947-021-00248-z

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…In recent years, several studies have demonstrated an association between LASr and LVDD as well as increased LVFP in patients with coronary heart disease, heart failure, among others, and LA stiffness index are reliable parameters for identifying elevated LVEDP. 20,21 In this study, we applied these parameters to patients with AF and found that LASr, LA filling index, and LA stiffness index exhibited excellent accuracy in detecting elevated LAP, and non-inferior to the performance of conventional echocardiographic parameters commonly used for assessing LAP in AF patients. Furthermore, we pro-…”

Section: Discussionmentioning

confidence: 91%

Left atrial strain parameters to predicting elevated left atrial pressure in patients with atrial fibrillation

Xu,

Zhou,

et al. 2024

Echocardiography

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ObjectivesTo assess the ability of left atrial (LA) strain parameters to discriminate patients with elevated left atrial pressure (LAP) from patients with atrial fibrillation (AF).Methods and resultsA total of 142 patients with non‐valvular AF who underwent first catheter ablation (CA) between November 2022 and November 2023 were enrolled in the study. Conventional and speckle‐tracking echocardiography (STE) were performed in all patients within 24 h before CA, and LAP was invasively measured during the ablation procedure. According to mean LAP, the study population was classified into two groups of normal LAP (LAP < 15 mmHg, n = 101) and elevated LAP (LAP ≥ 15 mmHg, n = 41). Compared with the normal LAP group, elevated LAP group showed significantly reduced LA reservoir strain (LASr) [9.14 (7.97–11.80) vs. 20 (13.59–26.96), p < .001], and increased LA filling index [9.60 (7.15–12.20) vs. 3.72 (2.17–5.82), p < .001], LA stiffness index [1.13 (.82–1.46) vs. .47 (.30–.70), p < .001]. LASr, LA filling index and LA stiffness index were independent predictors of elevated LAP after adjusted by the type of AF, EDT, E/e′, mitral E, and peak acceleration rate of mitral E velocity. The receiver‐operating characteristic curve (ROC) analysis showed LA strain parameters (area under curve [AUC] .794–.819) could provide similar or greater diagnostic accuracy for elevated LAP, as compared to conventional echocardiographic parameters. Furthermore, the novel algorithms built by LASr, LA stiffness index, LA filling index, and left atrial emptying fraction (LAEF), was used to discriminate elevated LAP in AF with good accuracy (AUC .880, accuracy of 81.69%, sensitivity of 80.49%, and specificity of 82.18%), and much better than 2016 ASE/EACVI algorithms in AF.ConclusionIn patients with AF, LA strain parameters could be useful to predict elevated LAP and non‐inferior to conventional echocardiographic parameters. Besides, the novel algorithm built by LA strain parameters combined with conventional parameters would improve the diagnostic efficiency.

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Section: Discussionmentioning

confidence: 91%

Left atrial strain parameters to predicting elevated left atrial pressure in patients with atrial fibrillation

Xu,

Zhou,

et al. 2024

Echocardiography

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“…LA reservoir strain (LASr) has been demonstrated to be a surrogate marker for LV filling pressure. In patients with elevated LV end diastolic pressure (measured by invasive catheterization), LASr was significantly reduced (sensitivity 74.2%, specificity 94.4%) 133 . Furthermore a reduction in LASr has been associated with increased pulmonary vascular resistance and reduced peak oxygen consumption.…”

Section: Cardiac Remodelling With Angiotensin Receptor Neprilysin Inh...mentioning

confidence: 98%

“…In patients with elevated LV end diastolic pressure (measured by invasive catheterization), LASr was significantly reduced (sensitivity 74.2%, specificity 94.4%). 133 Furthermore a reduction in LASr has been associated with increased pulmonary vascular resistance and reduced peak oxygen consumption. In HFpEF, LASr was most strongly correlated with adverse events, and independently associated with cardiovascular hospitalizations or death when compared with LV, RV, and LA strain.…”

Section: Cardiac Remodelling With Angiotensin Receptor Neprilysin Inh...mentioning

confidence: 99%

Cardiac reverse remodelling by imaging parameters with recent changes to guideline medical therapy in heart failure

Kodsi,

Makarious,

Gan

et al. 2023

ESC Heart Failure

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Recently established heart failure therapies, including sodium glucose co‐transporter 2 inhibitors, angiotensin‐neprilysin inhibitors, and cardiac resynchronization therapy, have led to both clinical and structural improvements. Reverse remodelling describes the structural and functional responses to therapy and has been shown to correlate with patients' clinical response, acting as a biomarker for treatment success. The introduction of these new therapeutic agents in addition to advances in non‐invasive cardiac imaging has led to an expansion in the evaluation and the validation of cardiac reverse remodelling. Methods including volumetric changes as well as strain and myocardial work have all been shown to be non‐invasive end‐points of reverse remodelling, correlating with clinical outcomes. Our review summarizes the current available evidence on reverse remodelling in heart failure by the non‐invasive cardiac imaging techniques, in particular transthoracic echocardiography.

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“… 5 Several studies have shown that left atrial strain is negatively correlated well with LVFP or PCWP. 6 , 7 , 8 , 9 However, diastolic dysfunction per se is not tantamount to HFpEF.…”

Section: Introductionmentioning

confidence: 99%

The novel left atrial strain parameters in diagnosing of heart failure with preserved ejection fraction

Liao

Fan

et al. 2022

Echocardiography

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Objectives:We sought to evaluate the ability of the novel LA strain parameters to discriminate patients with heart failure with preserved ejection fraction (HFpEF) from individuals with risk factors of HFpEF. Methods and results:A total of n = 389 patients with risk factors for HFpEF finally was prospectively enrolled into the study, 66 of them were diagnosed with HFpEF by the 2021 ESC HF guidelines. Fifty-five patients were undergone left ventricular catheterization and simultaneous transthoracic echocardiography was performed, 35 of them with elevated left ventricular end-diastolic pressure (LVEDP). Left atrial reservoir strain (LASr) was measured in all patients. LA filling index was defined as the ratio of mitral E and LASr and LA stiffness index was calculated as E/e′/LASr. Compared with the patients in the normal LVEDP subgroup, those in the elevated LVEDP subgroup showed significantly higher LA filling index, LA stiffness index, and LAVI/LASr. The receiver-operating characteristic curve (ROC) analysis showed LASr (area under curve [AUC] .840), LA filling index (AUC .843), LA stiffness index (AUC .766), and LAVI/LASr (AUC .755) had good diagnostic accuracy for elevated LVEDP. Inter-technique agreement analysis showed the novel algorithms with LA strain parameters had good agreement with the invasive LVEDP measurement, better than the 2016 ASE/SCAI algorithms (kappa .711 vs. .101). Furthermore, compared with patients without HFpEF, LASr was lower in HFpEF, LA filling index, LA stiffness index, and LAVI/LASr was higher in patients with HFpEF. ROC analysis showed the novel LA strain parameters with good accuracy (AUC .756 to .821) non-inferior to conventional echocardiographic parameters could identify HFpEF, and LA stiffness index (AUC .821) was the best one. Conclusion:The novel LA strain parameters could be of potential usefulness in estimating LVEDP and incorporated into the 2016 EACVI/ASE criteria would improve the diagnostic efficiency. The novel LA strain parameters with good accuracy non-inferior to conventional echocardiographic parameters could discriminate HFpEF from patients with risk factors of HFpEF.

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Mitral early-diastolic inflow peak velocity (E)-to-left atrial strain ratio as a novel index for predicting elevated left ventricular filling pressures in patients with preserved left ventricular ejection fraction

Cited by 8 publications

References 20 publications

Left atrial strain parameters to predicting elevated left atrial pressure in patients with atrial fibrillation

Left atrial strain parameters to predicting elevated left atrial pressure in patients with atrial fibrillation

Cardiac reverse remodelling by imaging parameters with recent changes to guideline medical therapy in heart failure

The novel left atrial strain parameters in diagnosing of heart failure with preserved ejection fraction

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