Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure

Abstract

Aims The aim of this study is to investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as non-invasive markers of left ventricular (LV) filling pressure. Methods and results In a multicentre study of 322 patients with cardiovascular disease of different aetiologies, LA strain and other echocardiographic parameters were compared with invasively measured LV filling pressure. The strongest determinants of LA reservoir and pump strain were LV global longitudinal strain (GLS) (r-values 0.64 and 0.51, respectively) and LV filling pressure (r-values −0.52 and −0.57, respectively). Left atrial volume was another independent, but weaker determinant of both LA strains. For both LA strains, association with LV filling pressure was strongest in patients with reduced LV ejection fraction. Left atrial reservoir strain <18% and LA pump strain <8% predicted elevated LV filling pressure better (P < 0.05) than LA volume and conventional Doppler parameters. Accuracy to identify elevated LV filling pressure was 75% for LA reservoir strain alone and 72% for pump strain alone. When combined with conventional parameters, accuracy was 82% for both LA strains. In patients with normal LV systolic function by GLS, LA pump strain >14% identified normal LV filling pressure with 92% accuracy. Conclusion Left atrial reservoir and pump strain are determined predominantly by LV GLS and filling pressure. Accuracy of LA strains to identify elevated LV filling pressure was best in patients with reduced LV systolic function. High values of LA pump strain, however, identified normal LV filling pressure with good accuracy in patients with normal systolic function.

Comparative analysis of phasic left atrial strain and left ventricular posterolateral strain pattern to discriminate Fabry cardiomyopathy from other forms of left ventricular hypertrophy

“…The previously described pattern of PLSI is also matter of debate; previous data by Weidemann et al and Kramer et al 8,12 strongly suggest that impaired regional LV function may be caused by posterior and inferolateral LV wall thinning due to fibrosis following sphingolipid accumulation. Regarding the left atrium, impairment of LAS in many cardiomyopathies and thus also in FC could be partially explained by impaired diastolic LV function and consecutively elevated LV filling pressures, a hypothesis that was previously confirmed when assessing LA mechanics in general 26,27 and in FC. 18,19 LV filling pressures, LVGLS and LAVI were shown to be independent determinants of phasic LAS due to the anatomical connection of LV and LA.…”

“…18,19 LV filling pressures, LVGLS and LAVI were shown to be independent determinants of phasic LAS due to the anatomical connection of LV and LA. 27 However, phasic LAS showed significant reductions in the FC group while, in contrast, other parameters of LV systolic and diastolic function, that is, LVGLS, LAVI, E/e' , respectively, another study had not significant elevated relative wall thickness in their FC cohort (.4 ± .12 18 )) and LAVI (37.1 ml/m 2 ± 11.6 vs 25.9 ml/m 2 ± 10, 34 respectively) which could explain these differences and underscores that due to the scarce data collected so far in FC and in the face of differences in the selected cohorts it is difficult to make transferable cut-off values so far.…”

Left atrial reservoir strain provides incremental value to left atrial volume index for evaluation of left ventricular filling pressure

“…19 Of the three parameters, reservoir phase strain demonstrates the greatest diagnostic utility, with an inverse relationship with LVFP demonstrated in numerous invasively correlated trials. [9][10][11][12][13] The relationship between LVFP and LASr is driven by left atrial mechanical response to alterations in left ventricular loading conditions. Illustrated by left atrial pressure-volume loops, elevation of LVFP increases left atrial stiffness, with reduced tissue compliance produced by augmented volume and tensile load.…”

“…8 LASr demonstrates an inverse correlation with invasive LVFP and may be more accurate in assessing LVFP than LAVI. [9][10][11][12][13] Currently, however, there are a number of technical factors limiting routine clinical application of LASr, including: the absence of a clearly defined threshold for differentiating elevated LVFP, demonstration of the performance of LASr for diastolic assessment compared to conventional echocardiographic parameters, and demonstration of the reliability of LASr for predicting LVFP in patients with abnormal left atrial dilation. We performed a large scale, prospective trial examining LASr and conventional echocardiographic parameters in relation to invasive LVFP to clarify these limitations.…”

Heart Failure with Preserved Ejection Fraction Is a Still Big Unmet Need in Cardiology

“…Noninvasive diagnosis of LV diastolic dysfunction in patients with preserved LVEF is still challenging. The evaluation of left atrial strain may bring further progress for this purpose [ 8 ]. A diastolic stress test has high accuracy in diagnosing HFpEF [ 9 ]; however, it is time and human resource consuming, and is not suitable for all patients in whom HFpEF is suspected.…”