Atrial Function and Its Role in the Non-invasive Evaluation of Diastolic Function in Congenital Heart Disease

Ta, Hieu T.; Alsaied, Tarek; Steele, Jeremy; Truong, Vien T.; Mazur, Wojciech; Nagueh, Sherif F.; Kutty, Shelby; Tretter, Justin T.

doi:10.1007/s00246-020-02351-w

Cited by 22 publications

(18 citation statements)

References 69 publications

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“…Recently it was found that 18% of adolescents and 24% of young adults have pre-diabetes [1]. Non-invasive assessment of diastolic function remains challenging in the pediatric and young adult population as the findings of diastolic dysfunction may be the end point for long term exposure to harmful events and thus early detection is important to prevent development of heart failure symptoms [2,3]. Left atrium (LA) maximum volume has been shown to strongly correlate with cardiovascular outcomes and has improved prognostic and diagnostic information in the assessment of LV diastolic function [3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…However, recent literature suggests that LA function measures may be more sensitive early markers of LV diastolic dysfunction than LA volume data and LA strain impairment as measured by speckle tracking echocardiography may be one of the first signs of diastolic dysfunction [ 10 – 12 ]. The data in the pediatric and young adult population remains limited particularly as it pertains to LA dysfunction as a result of obesity and T2DM [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Left atrial strain and diastolic function abnormalities in obese and type 2 diabetic adolescents and young adults

Steele

Urbina

Mazur

et al. 2020

Cardiovasc Diabetol

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Background Adults with obesity and type 2 diabetes mellitus (T2DM) related to obesity are at increased risk of heart failure with preserved ejection fraction (HFpEF). Whether left ventricular (LV) diastolic function abnormalities related to obesity and T2DM start in adolescence and early adulthood is unknown. We non-invasively evaluated the differences seen in LV diastolic and left atrial (LA) function in adolescents and young adults with obesity and T2DM. Methods We analyzed echocardiographic measures of LV diastolic function in patients with structurally normal hearts which were divided into 3 groups (normal weight, obese, and T2DM). Spectral and tissue Doppler and 2-D speckle tracking measurements of diastolic function were obtained. Logistic regression was performed to compare the prevalence of abnormalities in diastolic function based on the worst 25th percentile for each measure to determine the prevalence of diastolic and LA function abnormalities in obese and T2DM patients. Results 331 teenagers and young adults (median age 22.1 years) were analyzed (101 normal weight, 114 obese, 116 T2DM). Obese and T2DM group had lower E/A and higher E/e′. Obese and T2DM patients had significantly lower atrial reservoir, conduit, and booster strain and worse reservoir and conduit strain rate compared to normal patients (p < 0.001 for all measures). All patients had normal LA volumes. On multivariable analysis, conduit strain and reservoir and conduit strain rate were independently associated with having below the 25th percentile e′. Conduit strain rate was independently associated with having below the 25th percentile for mitral E/A ratio on multivariable analysis. Conclusions Abnormal indices of LV diastolic function are detected in adolescents and young adults with obesity and T2DM. LA function and strain analysis were able to detect evidence of decreased reservoir, conduit, and booster strain in these patients although LA volume was normal. The use of LA function strain may increase our ability to detect early diastolic function abnormalities in this population.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Left atrial strain and diastolic function abnormalities in obese and type 2 diabetic adolescents and young adults

Steele

Urbina

Mazur

et al. 2020

Cardiovasc Diabetol

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“…Tricuspid E/e′ has been used to estimate RV filling pressure 26) ; however, the E/e′ ratio is reportedly correlated to filling pressures on the condition that impaired relaxation of ventricles exists, which might not often be present in children. 27) Also, the tricuspid E/e′ results in infants with BPD may not be entirely accurate due to the limitations of Doppler echocardiography, such as angle dependency and tethering of nearby myocardium. 7) Since more than one parameter is recommended for the assessment of RV diastolic dysfunction, 28) therefore, utilizing PLRAS in addition to conventional echocardiographic parameters of RV diastolic dysfunction such as tricuspid E/e′ would help in the effective detection of RV diastolic dysfunction in infants with BPD.…”

Section: Discussionmentioning

confidence: 99%

Right Atrial Strain in Preterm Infants With a History of Bronchopulmonary Dysplasia

Kang

Jung

Hwang

et al. 2022

J Cardiovasc Imaging

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BACKGROUND Few studies have utilized right atrial (RA) strain to evaluate right ventricular (RV) diastolic dysfunction in preterm infants with bronchopulmonary dysplasia (BPD). We aimed to evaluate the associations of RA strain with BPD severity and respiratory outcomes in preterm infants with BPD. METHODS We retrospectively studied 153 infants with BPD born before 32 weeks of gestational age at CHA Bundang Medical Center. Peak longitudinal right atrial strain (PLRAS) was obtained using velocity vector imaging and compared among infants across BPD severity. Conventional echocardiographic parameters and clinical characteristics were also evaluated. RESULTS In infants with severe BPD, mean gestational age (27.4 ± 2.1 weeks) and mean birth weight (971.3 ± 305.8 g) were significantly smaller than in those with mild BPD (30.0 ± 0.9 weeks, 1,237.3 ± 132.2 g) and moderate BPD (29.6 ± 1.3 weeks, 1,203.2 ± 214.4 g). PLRAS was significantly lower in infants with severe BPD (26.3 ± 10.1%) than in those in the moderate BPD group (32.4 ± 10.9%) or mild BPD group (31.9 ± 8.3%). Tricuspid E/e′ and maximum RA volume index were similar across BPD severity. A decrease in PLRAS was significantly correlated with increased duration of mechanical ventilation duration; however, tricuspid E/e′ and maximum RA volume index were not. CONCLUSIONS Evaluating PLRAS with other parameters in infants with BPD might detect RV diastolic dysfunction. Longer follow-up and larger study populations may elucidate the association between PLRAS and respiratory outcomes in infants with BPD.

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“…1 Non-invasive assessment of diastolic function remains challenging in the pediatric and young adult population as the ndings of diastolic dysfunction may be the end point for long term exposure to harmful events and thus early detection is important to prevent development of heart failure symptoms. 2,3 Left atrium (LA) maximum volume has been shown to strongly correlate with cardiovascular outcomes and has improved prognostic and diagnostic information in the assessment of LV diastolic function. [3][4][5]6,7,8 LA dilation results from chronically elevated LV lling pressures and thus is a late nding that happens in late stage I or stage II diastolic dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“…10,11,12 The data in the pediatric and young adult population remains limited particularly as it pertains to LA dysfunction as a result of obesity and T2DM. 2 In our study we compared diastolic function and LA strain measures of adolescents and young adults who were either normal weight, obese, or diagnosed with T2DM. We hypothesized that diastolic function and LA strain function measures are impaired in patients with obesity and further impaired in T2DM as compared to the normal controls and that there are associations between LA function measures and measures of diastolic dysfunction in adolescents and young adults.…”

Section: Introductionmentioning

confidence: 99%

Left Atrial Strain and Diastolic Function Abnormalities in Obese and Type 2 Diabetic Adolescents and Young Adults.

Steele

Urbina

Mazur

et al. 2020

Preprint

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Background: Adults with obesity and type 2 diabetes mellitus (T2DM) related to obesity are at increased risk of heart failure with preserved ejection fraction (HFpEF). Whether left ventricular (LV) diastolic function abnormalities related to obesity and T2DM start in adolescence and early adulthood is unknown. We non-invasively evaluated the differences seen in LV diastolic and left atrial (LA) function in adolescents and young adults with obesity and T2DM. Methods: We analyzed echocardiographic measures of LV diastolic function in patients with structurally normal hearts which were divided into 3 groups (normal weight, obese, and T2DM). Spectral and tissue Doppler and 2-D speckle tracking measurements of diastolic function were obtained. Logistic regression was performed to compare the prevalence of abnormalities in diastolic function based on the worst 25th percentile for each measure to determine the prevalence of diastolic and LA function abnormalities in obese and T2DM patients. Results: 331 teenagers and young adults (median age 22.1 years) were analyzed (101 normal weight, 114 obese, 116 T2DM). Obese and T2DM group had lower E/A and higher E/e’. Obese and T2DM patients had significantly lower atrial reservoir, conduit, and booster strain and worse reservoir and conduit strain rate compared to normal patients (p<0.001 for all measures). All patients had normal LA volumes. On multivariable analysis, conduit strain and reservoir and conduit strain rate were independently associated with having below the 25th percentile e’. Conduit strain rate was independently associated with having below the 25th percentile for mitral E/A ratio on multivariable analysis.Conclusions: Abnormal indices of LV diastolic function are detected in adolescents and young adults with obesity and T2DM. LA function and strain analysis were able to detect evidence of decreased reservoir, conduit, and booster strain in these patients although LA volume was normal. The use of LA function strain may increase our ability to detect early diastolic function abnormalities in this population.

show abstract

Atrial Function and Its Role in the Non-invasive Evaluation of Diastolic Function in Congenital Heart Disease

Cited by 22 publications

References 69 publications

Left atrial strain and diastolic function abnormalities in obese and type 2 diabetic adolescents and young adults

Left atrial strain and diastolic function abnormalities in obese and type 2 diabetic adolescents and young adults

Right Atrial Strain in Preterm Infants With a History of Bronchopulmonary Dysplasia

Left Atrial Strain and Diastolic Function Abnormalities in Obese and Type 2 Diabetic Adolescents and Young Adults.

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