Correlation of Left Atrial Strain and Doppler Measurements with Invasive Measurement of Left Ventricular End‐Diastolic Pressure in Patients Stratified for Different Values of Ejection Fraction

Abstract

Background: This study aimed at exploring the correlation of left atrial longitudinal function by speckle tracking echocardiography (left atrial strain) and Doppler measurements (E/E' ratio) with direct measurements of left ventricular (LV) end-diastolic pressure (LVEDP) in patients stratified for different values of ejection fraction. Methods: The study population was 80 stable patients with sinus rhythm undergoing cardiac catheterization. This population was selected in order to have four groups of 20 patients each with different LV ejection fraction (>55%, 45-54%, 30-44%, and <30%). LVEDP was obtained during cardiac catheterization; peak atrial longitudinal strain (PALS) and mean E/E' ratio were measured in all subjects. Results: Similar correlations with LVEDP of global PALS and E/E' ratio were recorded in patients with preserved (r = À0.79 vs. r = 0.72, respectively; P < 0.0001 for both) or mildly reduced ejection fraction (r = À0.75 vs. r = 0.73, respectively; P < 0.0001 for both). A closer correlation of global PALS compared to E/E' ratio was evident in patients with moderate (r = À0.78 P < 0.0001; vs. r = 0.47 P = 0.01, respectively) and severe reduction (r = À0.74 P < 0.0001; vs. r = 0.19 ns, respectively) of LV ejection fraction. In multivariate analysis of all measurements, global PALS emerged as a determinant of the LVEDP, independent on other confounding factors and, with the cutoff value of 18.0% presented the best diagnostic accuracy to predict a LVDP above 12 mmHg (AUC 0.87). Conclusions: In patients with preserved or mildly reduced LV ejection fraction, global PALS and mean E/E' ratio presented good correlations with LVEDP. In patients with moderate or severe reduction of ejection fraction, E/E' ratio correlated poorly with invasively obtained LV filling pressures. Global PALS provided an overall better estimation of LV filling pressures. (Echocardiography 2016;33:398-405)

LA Strain for Categorization of LV Diastolic Dysfunction

“…Furthermore, peak LA strain was shown to correlate well with LV filling pressures in studies of patients with systolic HF, suggesting peak LA strain to be a potentially good noninvasive marker of elevated filling pressures (19,20). However peak LA strain is susceptible to the effects of age, obesity, valvular disease, such as mitral regurgitation, and atrial fibrillation, which we accounted for in this study by limiting our study population to patients with normal LVEF and no significant valvulopathy (21-23).…”

Left atrial function: evaluation by strain analysis

“…Compared with patients with normal diastolic function, patients with mild diastolic dysfunction had significantly reduced E sr and S sr but increased A sr. Another study (42) demonstrated that LA systolic strain (measured using STE) inversely correlated with LV end diastolic pressure. Similar to the E/E' ratio, LA systolic strain correlates with LV end diastolic pressure in patients with preserved or mildly reduced LVEF, whereas in patients with moderate or severe reduction of EF, E/E' correlated poorly and LA systolic strain provided a better estimation of LV filling pressures.…”

Atrial remodelling in heart failure: recent developments and relevance for heart failure with preserved ejection fraction

“…In chronic conditions, LA volume and strain correlate with LV end‐diastolic pressures irrespective of EF 75, 76. Mechanical stress induces stretching and stiffening of the atria 77.…”