Potential Usefulness and Clinical Relevance of Adding Left Atrial Strain to Left Atrial Volume Index in the Detection of Left Ventricular Diastolic Dysfunction

Morris, Daniel A.; Belyavskiy, Evgeny; Aravind-Kumar, Radhakrishnan; Kropf, Martin; Frydas, Athanasios; Braunauer, Kerstin; Marquez, Esteban; Krisper, Maximilian; Lindhorst, Ruhdja; Osmanoglou, Engin; Boldt, Leif‐Hendrik; Blaschke, Florian; Haverkamp, Wilhelm; Tschöpe, Carsten; Edelmann, Frank; Pieske, Burkert; Pieske‐Kraigher, Elisabeth

doi:10.1016/j.jcmg.2017.07.029

Cited by 252 publications

(203 citation statements)

References 31 publications

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“…However, we do feel that it has potential for final adjudication of filling pressures in subjects with normal LV function. In fact, this idea has been recently explored by Morris et al in a study suggested that adding LA strain to LAVi in may be helpful in the diagnosis of diastolic dysfunction on patients with preserved LV EF [20]. Some scenarios that come to mind, where LS strain may indeed be useful include indeterminate diastolic function, or patients in whom the inability to assess the major diastolic parameters is limited, e.g.…”

Section: Discussionmentioning

confidence: 99%

Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures

Singh

Medvedofsky

Mediratta

et al. 2018

Int J Cardiovasc Imaging

111

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Echocardiographic assessment of left ventricular (LV) filling pressures is performed using a multi-parametric algorithm. Left atrial (LA) strain was recently found to accurately classify the degree of diastolic dysfunction. We hypothesized that LA strain could be used as a stand-alone marker and sought to identify and test a cutoff, which would accurately detect elevated LV pressures. We studied 76 patients with a spectrum of LV function who underwent same-day echocardiogram and invasive left-heart catheterization. Speckle tracking was used to measure peak LA strain. The protocol involved a retrospective derivation group (N = 26) and an independent prospective validation cohort (N = 50) to derive and then test a peak LA strain cutoff which would identify pre-A-wave LV diastolic pressure > 15 mmHg. The guidelines-based assessment of filling pressures and peak LA strain were compared side-by-side against invasive hemodynamic data. In the derivation cohort, receiver-operating characteristic analysis showed area under curve of 0.76 and a peak LA strain cutoff < 20% was identified as optimal to detect elevated filling pressure. In the validation cohort, peak LA strain demonstrated better agreement with the invasive reference (81%) than the guidelines algorithm (72%). The improvement in classification using LA strain compared to the guidelines was more pronounced in subjects with normal LV function (91% versus 81%). In summary, the use of a peak LA strain to estimate elevated LV filling pressures is more accurate than the current guidelines. Incorporation of LA strain into the non-invasive assessment of LV diastolic function may improve the detection of elevated filling pressures.

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Section: Discussionmentioning

confidence: 99%

Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures

Singh

Medvedofsky

Mediratta

et al. 2018

Int J Cardiovasc Imaging

111

View full text Add to dashboard Cite

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“…In a recent trial 45% of patients had ‘early’ HFpEF with normal filling pressures at rest, and elevated filling pressures only during invasive haemodynamic exercise testing 5 . Because of the intermittent diastolic pressure overload in early HFpEF, LAVI may be smaller (and less diagnostic), and functional indices such as global LA strain or LA conduit strain might be more appropriate diagnostic parameters 276 . In consequence, the patient mix under investigation may affect the test results.…”

Section: Calculating and Interpreting The Hfa–peff Scorementioning

confidence: 99%

“…The E / e ′ index has gained a supremacy in clinical practice that is not fully supported by all clinical investigations 288 , 289 . The diagnostic utility of alternative indices such as retrograde pulmonary venous flow, 290 , 291 estimated LV stiffness (diastolic pressure–volume quotient), 284 and LA strain rate during atrial contraction 74 , 161 , 276 , 292 in patients in SR, and the L wave of mitral inflow 293 and LA strain during reservoir function 160 , 294 in patients in AF, merit further investigation.…”

Section: Calculating and Interpreting The Hfa–peff Scorementioning

confidence: 99%

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Pieske

Tschöpe

Boer

et al. 2020

European J of Heart Fail

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387

637

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Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the ‘HFA–PEFF diagnostic algorithm’. Step 1 (P=Pre‐test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non‐cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e′), LV filling pressure estimated using E/e′, left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2–4 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.

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“…The transition from an asymptomatic to a symptomatic state is very hard to disclose but at the same time essential to define the best timing to operate. Even though global longitudinal strain (GLS) is altered before a decrease in LVEF or before LV dilatation, evidence suggests that an impairment of LAS might precede clear LV strain deterioration in different clinical settings, such as valvular heart disease and diastolic dysfunction …”

Section: Discussionmentioning

confidence: 99%

The role of the left atrial function in the surgical management of aortic and mitral valve disease

et al. 2019

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The right management of both mitral and aortic disease can be challenging, especially in asymptomatic patients. The current guidelines recommend valve repair or replacement when symptoms arise or when there is an evident left ventricular dysfunction. However, deciding the optimal surgical timing can be very difficult, since the line between the absence of symptoms and being minimally symptomatic, especially in the elderly, is blurred. Another relevant issue regards the second surgical criterion: operating on a patient with a reduced left ventricular ejection fraction or with a dilated left ventricle might jeopardize the possibility of a fully reverse remodeling of the heart after surgery. In this scenario, the left atrium might play an important role. In particular, left atrial deformation might be a very useful tool to detect early ultrastructural alterations, and help or support guiding a patient‐tailored treatment at an early stage, optimizing the outcome in the long term.

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Potential Usefulness and Clinical Relevance of Adding Left Atrial Strain to Left Atrial Volume Index in the Detection of Left Ventricular Diastolic Dysfunction

Abstract: The findings from this study provide important insights regarding the potential usefulness and clinical relevance of adding LA strain to LAVI in the detection of LVDD in patients with preserved LVEF.

Cited by 252 publications

References 31 publications

Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures

Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

The role of the left atrial function in the surgical management of aortic and mitral valve disease

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