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

Tomlinson, S.; Scalia, G.; Appadurai, Vinesh; Edwards, Natalie; Savage, M.; Lam, Alfred King‐Yin; Chan, Jonathan

doi:10.1111/echo.15157

Cited by 10 publications

(7 citation statements)

References 29 publications

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“…The current echocardiographic guideline algorithm uses LAVi in the evaluation of diastolic function ( 21 ). However, LASr showed excellent correlation with left ventricular filling pressure independent from LAVi ( 30 ), therefore LASr was suggested as a more accurate parameter to assess elevated filling pressure and diastolic dysfunction especially in early phases ( 13 , 31 , 32 ). LA strain can discriminate the severity grade of diastolic dysfunction ( 33 ), is associated with higher level of fibrosis of the atrial wall ( 14 ) and increased risk for arrhythmias or thromboembolic events ( 34 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

The Predictive Value of Left Atrial Strain Following Transcatheter Aortic Valve Implantation on Anatomical and Functional Reverse Remodeling in a Multi-Modality Study

Vattay

Nagy

Apor

et al. 2022

Front. Cardiovasc. Med.

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IntroductionTranscatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and survival. Data on the predictive value of left atrial (LA) strain following TAVI are scarce. We aimed to evaluate the association of LA strain measured shortly post-TAVI with functional and anatomical reverse remodeling of the LA and LV, and its association with mortality.MethodsWe prospectively investigated 90 patients who underwent TAVI. Transthoracic echocardiography including strain analysis was performed shortly after TAVI and repeated 6 months later. CT angiography (CTA) was performed for pre-TAVI planning and 6 months post-TAVI. Speckle tracking echocardiography was used to determine LA peak reservoir strain (LASr) and LV global longitudinal strain (LV-GL), LA volume index (LAVi) was measured by TTE. LV mass index (LVMi) was calculated using CTA images. LA reverse remodeling was based on LASr and LAVi changes, whereas LV reverse remodeling was defined as an improvement in LV-GLS or a reduction of LVMi. The association of severely reduced LASr (<20%) at baseline with changes (Δ) in LASr, LAVi, LV-GLS and LVMi were analyzed using linear regression, and Cox proportional hazard model for mortality.ResultsMean LASr and LV-GLS were 17.7 ± 8.4 and −15.3 ± 3.4% at baseline and 20.2 ± 10.2 and −16.6 ± 4.0% at follow-up (p = 0.024 and p < 0.001, respectively). Severely reduced LASr at baseline was associated with more pronounced ΔLASr (β = 5.24, p = 0.025) and LVMi reduction on follow-up (β = 5.78, p = 0.036), however, the majority of the patients had <20% LASr on follow-up (44.4%). Also, ΔLASr was associated with ΔLV-GLS (adjusted β = 2.10, p < 0.001). No significant difference in survival was found between patients with baseline severely reduced LASr (<20%) and higher LASr (≥20%) (p = 0.054).ConclusionLV reverse remodeling based on LVMi was present even in patients with severely reduced LASr following TAVI, although extensive LA damage based on LA strain was demonstrated by its limited improvement over time.Clinical Trial Registration(ClinicalTrials.gov number: NCT02826200).

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Section: Discussionmentioning

confidence: 99%

The Predictive Value of Left Atrial Strain Following Transcatheter Aortic Valve Implantation on Anatomical and Functional Reverse Remodeling in a Multi-Modality Study

Vattay

Nagy

Apor

et al. 2022

Front. Cardiovasc. Med.

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“…LAVI has been established as the only recommended parameter for evaluating LA morphological changes in clinical practice (3). LA strain, as an emerging parameter of LA function, was proven to be strongly correlated with LV end-diastolic filling pressure (23)(24)(25). It is a more sensitive marker than is LAVI for The data are presented as the mean ± standard deviation or median with interquartile range.…”

Section: Discussionmentioning

confidence: 99%

Identification of heart failure with preserved ejection fraction in patients with hypertension: a left atrial myocardial strain cardiac magnetic resonance study

Wen¹,

Zhang²,

Li³

et al. 2023

Quant Imaging Med Surg

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Background: The noninvasive diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. The role of left atrial (LA) functional changes in patients with HFpEF has attracted increased attention. This study aimed to evaluate LA deformation in patients with hypertension (HTN) using cardiac magnetic resonance tissue tracking and to investigate the diagnostic value of LA strain for HFpEF.Methods: This retrospective study consecutively enrolled 24 HTN patients with HFpEF (HTN-HFpEF) and 30 patients with pure HTN based on clinical indications. Thirty age-matched healthy participants were also enrolled. All participants underwent a laboratory examination and 3.0 T cardiovascular magnetic resonance (CMR). The LA strain and strain rate, including total strain (εs), passive strain (εe), active strain (εa), peak positive strain rate (SRs), peak early negative strain rate (SRe), and peak late negative strain rate (SRa), were evaluated using CMR tissue tracking and compared among the 3 groups. Receiver operating characteristic (ROC) analysis was used to identify HFpEF. Spearman correlation was used to analyze the correlation between LA strain and brain natriuretic peptide (BNP) level.Results: Patients with HTN-HFpEF had significantly lower εs (17.70%, IQR 14.65% to 19.70%; εe 7.83%±2.86%), εa (9.08%±3.19%), SRs (0.88±0.24/s), SRe (−0.60/s, IQR −0.90 to −0.50/s), and SRa (−1.10±0.47/s) than did patients with HTN and control participants (all P values <0.05). Compared to the control group, patients with HTN had lower εs (25.35%, IQR 21.80% to 27.25%), εe (11.49%±2.64%), SRs (1.10/s, IQR 1.00 to 1.48/s), and SRe (−1.11±0.37/s) (all P values <0.05). The values of εa and SRa were not significantly different between the HTN and control groups. LA total strain εs was independently associated with HFpEF (odds ratio 0.009; P<0.05) with a cutoff value of 19.55% (95% CI: 0.882-0.996), and the sensitivity and specificity were 75% and 97%, respectively. There was a good correlation between the LA strain parameters and BNP level (all P values <0.05).Conclusions: LA function impairment exists in patients with HFpEF. The LA strain parameter has potential value in diagnosing HFpEF.

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“…The increase in the left atrial maximum volume index may indicate LVDD. The correlation coefficients between the maximum volume index of the left atrium and invasive filling pressure parameters across studies ( 32 , 33 ), and the efficiency of diagnosing the increase in left ventricular filling pressure is also inconsistent ( 34 – 36 ). This finding suggests that the left atrial maximum volume index is unstable for evaluating LVDD.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two echocardiography-based methods for evaluating pediatric left ventricular diastolic dysfunction

Xiang,

Zhu,

Zheng

et al. 2023

Front. Pediatr.

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ObjectivesTo investigate the consistency between the 2016 America Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guideline-based recommendations and the body surface area (BSA)-transformed Z value-based cut-off for the assessment of left ventricular diastolic function (LVDF) in children.MethodsClinical data of children with heart failure (HF) and those with a high risk of HF and a low risk of HF were collected from the Children's Hospital of Chongqing Medical University between March 2021 and October 2022. The mitral annular e′ velocity, lateral E/e′ ratio, left atrial volume index, and peak tricuspid regurgitation velocity were detected by Echocardiography. The cut-off values recommended by the 2016 ASE/EACVI guidelines and the cut-off value based on the BSA-transformed Z value were used to evaluate LVDF. The consistencies and differences of the two criteria were compared.ResultsA total of 132 children with HF, 189 with a high risk of HF, and 231 with a low risk of HF, were enrolled. The consistency of the two criteria in evaluating LVDF in children with HF and with high risk of HF was moderate, with weighted kappa coefficients of 0.566 and 0.468, respectively (P < 0.001). The positivity rate of left ventricular diastolic dysfunction (LVDD) with Z value-based criteria (HF group, 23.5%; high-risk group, 8.5%) was higher than that with guideline-based criteria (HF group, 15.6%; high-risk group, 3.2%). In children with a low risk of HF, no case with LVDD was found. The consistency between the two criteria for grading the degree of LVDD was moderate, with a kappa coefficient of 0.522 (P = 0.001). The degree of LVDD according to the Z value-based criteria was higher than that of the guideline-based criteria (P = 0.004).ConclusionsThe Z value-based criteria used to evaluate LVDD in children with HF and high risk of HF may be more conducive to the early identification of LVDD, thereby permitting the possibility of early treatment intervention.

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

Cited by 10 publications

References 29 publications

The Predictive Value of Left Atrial Strain Following Transcatheter Aortic Valve Implantation on Anatomical and Functional Reverse Remodeling in a Multi-Modality Study

The Predictive Value of Left Atrial Strain Following Transcatheter Aortic Valve Implantation on Anatomical and Functional Reverse Remodeling in a Multi-Modality Study

Identification of heart failure with preserved ejection fraction in patients with hypertension: a left atrial myocardial strain cardiac magnetic resonance study

Comparison of two echocardiography-based methods for evaluating pediatric left ventricular diastolic dysfunction

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