Potential usefulness and clinical relevance of a novel left atrial filling index to estimate left ventricular filling pressures in patients with preserved left ventricular ejection fraction

Braunauer, Kerstin; Düngen, Hans‐Dirk; Belyavskiy, Evgeny; Aravind-Kumar, Radhakrishnan; Frydas, Athanasios; Kropf, Martin; Huang, Feiqiong; Marquez, Esteban; Tadić, Marijana; Osmanoglou, Engin; Edelmann, Frank; Tschöpe, Carsten; Boldt, Leif‐Hendrik; Pieske, Burkert; Pieske‐Kraigher, Elisabeth; Morris, Daniel A.

doi:10.1093/ehjci/jez272

Cited by 24 publications

(19 citation statements)

References 20 publications

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“…Peak torque of the left leg in patients with HFpEF was inversely associated with E/LAS. The elevated novel LA filling index (E/LAS ratio) was recently shown to be an effective and useful parameter to determine the elevated LV filling pressure in patients with HFpEF 26 . Accordingly, our findings show that HFpEF patients with elevated LV filling pressure (elevated E/LAS ratio) correlated with reduced muscle strength of legs.…”

Section: Discussionsupporting

confidence: 60%

Relation of left atrial function with exercise capacity and muscle endurance in patients with heart failure

et al. 2021

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Aims Both left atrial strain (LAS) and skeletal muscle endurance demonstrate a linear relationship to peak VO 2 . Less is known about the relationship between central (cardiac) and peripheral (muscle endurance) limitations of exercise capacity in patients with heart failure (HF). We investigated this relationship using novel cardiac markers such as LAS and left atrial emptying fraction (LAEF). Methods and resultsWe analysed echocardiographic measurements, cardiopulmonary exercise testing (CPET), and isokinetic muscle function in 55 subjects with HF and controls [17 heart failure with preserved ejection fraction (HFpEF), 18 heart failure with reduced ejection fraction (HFrEF), and 20 healthy controls]. Patients with reduced LAEF showed reduced peak VO 2 : 14.3 ± 3.5 vs. 18.5 ± 3.5 mL/min/kg, P = 0.003, and reduced muscle endurance (RME): 64.3 ± 23.9 vs. 88.5 ± 32.3 Nm/kg, P = 0.028. Patients with reduced LAS showed similar results. Neither left ventricular global longitudinal strain (LVGLS) nor left atrial volume index (LAVI) was associated with RME. The area under the curve of LAS and LAEF in patients with HF in association with RME were (0.76 vs. 0.80) with 95% confidence interval (CI) (0.59-0.96, P = 0.012 vs. 0.63-0.98, P = 0.006, respectively). In a multiple linear regression, LAEF and working load measured during CPET (watt) were independent factors for RME after adjusting for age, LVGLS, and 6 min walk test (6MWT) [LAEF (B: 0.09, 95% CI: 1.01; 1.18, P = 0.024), working load (B: 0.05, 95% CI: 1.01; 1.08, P = 0.006)]. Peak torque of the left leg was associated with E/LAS (E: early diastolic) in patients with HFpEF (r = À0.6, P = 0.020). Endurance of the left leg was associated with LAEF (r = 0.79, P = 0.001) in patients with HFrEF.Conclusions LAS/LAEF are potential cardiac markers in demonstrating the link between cardiac and peripheral limitations of exercise capacity. Thus, integrating LAS/LAEF in the evaluation of exercise intolerance in patients with HF could be useful.

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Section: Discussionsupporting

confidence: 60%

Relation of left atrial function with exercise capacity and muscle endurance in patients with heart failure

et al. 2021

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“…Recently, several studies have shown that left atrial strain is impaired in patients with left ventricular diastolic dysfunction, 10 and left atrial strain is well correlated with LVFP or PCWP.6 – 9 Thus, the LA filling index, the ratio of the mitral E velocity over LASr, could reflect the LA functional changes (LASr) and current LV filling status (mitral E velocity). 20 LA stiffness index comprised of the best LA strain parameter and a preferable estimated LVFP parameter (E/e′) would reveal the LA compliance influenced by LV diastolic function and the LV function affected by LVFP. 21 LAVI/LASr combines LA structure (LAVI) and LA function parameters (LASr) which influenced by LV diastolic function.…”

Section: Discussionmentioning

confidence: 99%

“…Braunauer et al. study showed that LA filling index (AUC .82) had a good diagnostic performance to determine elevated LVFP, 20 and Lin et al. study found that LA stiffness index (AUC .83) was the most accurate parameter in identifying elevated LVEDP patients from those with coronary disease.…”

Section: Discussionmentioning

confidence: 99%

The novel left atrial strain parameters in diagnosing of heart failure with preserved ejection fraction

Liao

Fan

et al. 2022

Echocardiography

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Objectives:We sought to evaluate the ability of the novel LA strain parameters to discriminate patients with heart failure with preserved ejection fraction (HFpEF) from individuals with risk factors of HFpEF. Methods and results:A total of n = 389 patients with risk factors for HFpEF finally was prospectively enrolled into the study, 66 of them were diagnosed with HFpEF by the 2021 ESC HF guidelines. Fifty-five patients were undergone left ventricular catheterization and simultaneous transthoracic echocardiography was performed, 35 of them with elevated left ventricular end-diastolic pressure (LVEDP). Left atrial reservoir strain (LASr) was measured in all patients. LA filling index was defined as the ratio of mitral E and LASr and LA stiffness index was calculated as E/e′/LASr. Compared with the patients in the normal LVEDP subgroup, those in the elevated LVEDP subgroup showed significantly higher LA filling index, LA stiffness index, and LAVI/LASr. The receiver-operating characteristic curve (ROC) analysis showed LASr (area under curve [AUC] .840), LA filling index (AUC .843), LA stiffness index (AUC .766), and LAVI/LASr (AUC .755) had good diagnostic accuracy for elevated LVEDP. Inter-technique agreement analysis showed the novel algorithms with LA strain parameters had good agreement with the invasive LVEDP measurement, better than the 2016 ASE/SCAI algorithms (kappa .711 vs. .101). Furthermore, compared with patients without HFpEF, LASr was lower in HFpEF, LA filling index, LA stiffness index, and LAVI/LASr was higher in patients with HFpEF. ROC analysis showed the novel LA strain parameters with good accuracy (AUC .756 to .821) non-inferior to conventional echocardiographic parameters could identify HFpEF, and LA stiffness index (AUC .821) was the best one. Conclusion:The novel LA strain parameters could be of potential usefulness in estimating LVEDP and incorporated into the 2016 EACVI/ASE criteria would improve the diagnostic efficiency. The novel LA strain parameters with good accuracy non-inferior to conventional echocardiographic parameters could discriminate HFpEF from patients with risk factors of HFpEF.

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“…To a certain extent, this is consistent with the results of some recent studies. Braunauer et al found that an elevated E/LASr ratio was significantly associated with worse functional capacity and HF hospitalization at 2 years [17]. A study of patients with atrial fibrillation found that an elevated E/LA strain ratio was associated with HF hospitalizations or worse cardiovascular events [18].…”

Section: Discussionmentioning

confidence: 99%

Mitral early-diastolic inflow peak velocity (E)-to-left atrial strain ratio as a novel index for predicting elevated left ventricular filling pressures in patients with preserved left ventricular ejection fraction

Zhou

Zhao

Shen

et al. 2021

Cardiovasc Ultrasound

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Objectives We sought to explore the relationship between an index of left ventricular diastolic function parameters combined with left atrial strain and the diastolic function of patients with preserved ejection fraction. Methods We prospectively enrolled 388 patients with left ventricular ejection fraction (LVEF) ≥ 50%, 49 of whom underwent left heart catherization. Transthoracic echocardiography was performed within 12 h before or after the procedure. Left atrial (LA) strain was obtained by speckle tracking echocardiography. These patients served as the test group. The remaining patients (n = 339) were used to validate the diagnostic performance of the mitral early-diastolic inflow peak velocity (E)-to-left atrial reservoir strain ratio (E/LASr) in left ventricular diastolic dysfunction. Results Invasive measurements of LV end-diastolic pressure (LVEDP) demonstrated that the E/LASr ratio was increased in patients with elevated LVEDP [ 2.0 (1.8–2.2) vs 3.0 (2.6–4.0), p < 0.001] in the test group (n = 49). After adjusting for age, mitral A, E/e' ratio and β-blocker use, the E/LASr ratio was an independent predictor of elevated LVEDP and showed good diagnostic performance in determining elevated LVEDP [area under the curve (AUC) 0.903, cutoff value 2.7, sensitivity 74.2%, specificity 94.4%]. In the validation group (n = 339), the E/LASr ratio also performed well in diagnosing elevated left atrial pressure (LAP) (AUC 0.904, cutoff value 3.2, sensitivity 76.5%, specificity 89.0%), while with a cut-off value of 2.7, the E/LASr ratio showed high accuracy in discriminating elevated LAP. In addition, E/LASr was a good index of excellent diagnostic utility (AUC: 0.899 to 0.996) in the categorization of diastolic dysfunction grades. Regarding the clinical relevance of this index, the E/LASr ratio could accurately diagnose HF with preserved ejection fraction (HFpEF) (0.781), especially in patients with “indeterminate” status (AUC: 0.829). Furthermore, an elevated E/LASr ratio was significantly associated with the risk of rehospitalization due to major adverse cardiac events (MACEs) within one year (odds ratio: 1.183, 95% confidence interval: 1.067, 1.312). Conclusions In patients with EF preservation, the E/LASr ratio is a novel index for assessing elevated left ventricular filling pressure with high accuracy.

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Potential usefulness and clinical relevance of a novel left atrial filling index to estimate left ventricular filling pressures in patients with preserved left ventricular ejection fraction

Cited by 24 publications

References 20 publications

Relation of left atrial function with exercise capacity and muscle endurance in patients with heart failure

Relation of left atrial function with exercise capacity and muscle endurance in patients with heart failure

The novel left atrial strain parameters in diagnosing of heart failure with preserved ejection fraction

Mitral early-diastolic inflow peak velocity (E)-to-left atrial strain ratio as a novel index for predicting elevated left ventricular filling pressures in patients with preserved left ventricular ejection fraction

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