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

Ma, Changsheng; Liao, Yunjun; Fan, Jiali; Zhao, Xin; Su, Bo; Zhou, Baoyuan

doi:10.1111/echo.15304

Cited by 21 publications

(12 citation statements)

References 26 publications

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“…31,32 Novel parameters that describe LA stiffness could help differentiate between these two scenarios. 33,34 To improve the diagnostic accuracy of the existing guideline, new studies have confirmed the added value of parameters obtained with speckle tracking imaging. 35,36 We found that adding more ultrasound parameters to a multi-parameter algorithm to grade diastolic function led to a higher diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

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Echocardiography algorithms to assess high left atrial pressure and grade diastolic function in preterm infants

de Waal,

Phad,

Crendal

2023

Echocardiography

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BackgroundRelaxation, restoring forces, myocardial stiffness and atrial function determine left ventricular (LV) diastolic function. This study aims to provide a comprehensive assessment of diastolic function in preterm infants using conventional echocardiography and speckle tracking imaging and determine the diagnostic accuracy of various algorithms to detect high left atrial pressure (LAP).MethodsPreterm infants received an echocardiogram 1 week after birth and diastolic reference values were derived from the outer percentiles of stable preterm infants. Impaired relaxation, LV stiffness and high LAP were defined by using algorithms where at least half of the parameters were outside the normal range. Diastolic function was graded using the 2016 American Society of Echocardiography algorithm and expanded with the EA ratio and left atrial strain. The diagnostic accuracy of various algorithms to detect high LAP was determined with sensitivity analysis.ResultsWe studied 146 infants (59 stable) with a mean of 27(1) weeks gestation. Impaired relaxation, LV stiffness and high LAP were found in 8%, 7%, and 14% of infants. The patent ductus arteriosus was a contributing factor to high LAP and LV stiffness, not impaired relaxation. Diagnostic accuracy improved from 90% to 96% and sensitivity from 40% to 90% by adding left atrial strain to the 2016 algorithm.ConclusionVarious grades of diastolic dysfunction could be appreciated in preterm infants using a multi‐parameter approach. Adding left atrial strain improved sensitivity to detect infants with high LAP.

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Section: Discussionmentioning

confidence: 99%

“…LA volume is related to LV filling pressure in adults but does not always track acute changes in LV filling pressure, and can represent both acute high inflow states and more chronic changes 31,32 . Novel parameters that describe LA stiffness could help differentiate between these two scenarios 33,34 …”

Section: Discussionmentioning

confidence: 99%

Echocardiography algorithms to assess high left atrial pressure and grade diastolic function in preterm infants

de Waal,

Phad,

Crendal

2023

Echocardiography

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“…Atrial strain provides a parametric assessment of the atrium, including the reservoir, conduit and pump functions, and represents a novel and attractive ultrasound tool for the evaluation of diastolic dysfunction. Increased LV end-diastolic pressure relates to altered atrial mechanics, and the addition of left atrial strain to improve standard work-up of patients with suspected HFpEF has been hypothesized [72]. In CKD, the assessment of atrial strain provided added diagnostic and prognostic value [39], including association with major adverse cardiovascular events [40].…”

Section: Diastolic Functionmentioning

confidence: 99%

Cardiac Imaging Biomarkers in Chronic Kidney Disease

Valbuena-López

Camastra²,

Cacciotti³

et al. 2023

Biomolecules

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Uremic cardiomyopathy (UC), the peculiar cardiac remodeling secondary to the systemic effects of renal dysfunction, is characterized by left ventricular (LV) diffuse fibrosis with hypertrophy (LVH) and stiffness and the development of heart failure and increased rates of cardiovascular mortality. Several imaging modalities can be used to obtain a non-invasive assessment of UC by different imaging biomarkers, which is the focus of the present review. Echocardiography has been largely employed in recent decades, especially for the determination of LVH by 2-dimensional imaging and diastolic dysfunction by pulsed-wave and tissue Doppler, where it retains a robust prognostic value; more recent techniques include parametric assessment of cardiac deformation by speckle tracking echocardiography and the use of 3D-imaging. Cardiac magnetic resonance (CMR) imaging allows a more accurate assessment of cardiac dimensions, including the right heart, and deformation by feature-tracking imaging; however, the most evident added value of CMR remains tissue characterization. T1 mapping demonstrated diffuse fibrosis in CKD patients, increasing with the worsening of renal disease and evident even in early stages of the disease, with few, but emerging, prognostic data. Some studies using T2 mapping highlighted the presence of subtle, diffuse myocardial edema. Finally, computed tomography, though rarely used to specifically assess UC, might provide incidental findings carrying prognostic relevance, including information on cardiac and vascular calcification. In summary, non-invasive cardiovascular imaging provides a wealth of imaging biomarkers for the characterization and risk-stratification of UC; integrating results from different imaging techniques can aid a better understanding of the physiopathology of UC and improve the clinical management of patients with CKD.

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“…Therefore, echocardiography is needed to assess early changes in subclinical cardiac function in ESRD patients. [1][2][3] Evaluation of left atrial strain by speckle tracking imaging has been shown to play an important prognostic role in several different specific populations, [4][5][6][7] but there are few studies on evaluation of left atrial strain before and after single hemodialysis. Therefore, the present study compare the differences between pre-hemodialysis and normal controls, and the changes of echocardiography pre-and posthemodialysis, to investigate the influence of volume load on left atrial function.…”

Section: Introductionmentioning

confidence: 99%

Effect of hemodialysis on left atrial function in patients with end‐stage renal failure evaluated by two‐dimensional speckle tracking imaging

Miao,

Wang,

Yin

et al. 2024

Echocardiography

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ObjectiveWe sought to evaluate the left atrial (LA) strain parameters of maintenance hemodialysis (MHD) patients before and after dialysis by two dimensional speckle tracking imaging (2D‐STI), and to explore the effect of volume load change on LA function.MethodsSeventy‐six patients with end stage renal disease (ESRD) on hemodialysis (HD) were enrolled in the study protocol. The median duration of dialysis was 24.0 (7.5, 59.5) months. In addition, 30 healthy subjects were selected as control group. Comprehensive echocardiography was performed immediately before and after hemodialysis to compare the changes in left atrial function.ResultsRegarding LA strain parameters in patients of pre‐HD, the median (25th, 75th) LA reservoir, LA conduit, and LA contractile reserve were 28.0 (23.0, 34.5), −15.5 (−10.0, −21.5), −12.0 (−9.0, −16.0) respectively; the post‐HD were 26.0 (21.0, 29.0), −12.0 (−9, −15.5), −12.5 (−9, −15.5) respectively; and controls were 43.0 (36.0, 48.0), −24.0 (−18.0, −32.0), −17.0 (−15.0, −22.0) respectively. The left atrial strain parameters before HD were lower than controls, the differences were statistically significant, the p‐value were .000, .025, and .000, respectively. The reservoir function and conduit function of LA strain decreased after hemodialysis, the differences were statistically significant, the p‐value were .003 and .006, respectively. Regarding the contraction of LA, the differences between pre‐ and post‐HD were not statistically significant (p = .965).ConclusionHemodialysis removes excess water in human body, while LVGLS and Doppler parameters are greatly affected by reduced preload. New echocardiographic parameters, such as left atrial strain, can quantitatively evaluate the changes in left atrial function before and after hemodialysis in ESRD patients, which can provide valuable information for the overall cardiac evaluation in this specific population.

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

Cited by 21 publications

References 26 publications

Echocardiography algorithms to assess high left atrial pressure and grade diastolic function in preterm infants

Echocardiography algorithms to assess high left atrial pressure and grade diastolic function in preterm infants

Cardiac Imaging Biomarkers in Chronic Kidney Disease

Effect of hemodialysis on left atrial function in patients with end‐stage renal failure evaluated by two‐dimensional speckle tracking imaging

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