Echocardiographic left atrial stiffness index predicts high left ventricular filling pressures in patients with acute heart failure: an observational study
- 28.10.2024
- Original Paper
Erschienen in:
- Verfasst von
- Massimiliano Camilli
- Ludovica Amore
- Federico Ballacci
- Giulia Iannaccone
- Marco Giuseppe Del Buono
- Federica Giordano
- Francesca Graziani
- Tommaso Sanna
- Daniela Pedicino
- Francesco Burzotta
- Carlo Trani
- Gaetano Antonio Lanza
- Rocco Antonio Montone
- Nadia Aspromonte
- Laura Lupi
- Marianna Adamo
- Filippo Crea
- Antonella Lombardo
- Erschienen in
- Clinical Research in Cardiology | Ausgabe 10/2025
Abstract
Background
In acute heart failure (AHF) patients, non-invasive estimation of left ventricular filling pressures (LVFPs) appears crucial to guide management. Although poorly investigated, left atrial (LA) mechanics play a pivotal role in this setting. This report sought to assess the correlation of echocardiographic LA stiffness index with invasive LVFPs and its diagnostic accuracy as compared to other parameters used in clinical practice.
Methods
In this observational, prospective study, 104 patients with suspected acute coronary syndrome and signs/symptoms of AHF were enrolled. Available invasive estimation of LVFPs was required. Comprehensive echocardiography was performed for all patients, including LA reservoir strain (LARS). LA stiffness index was derived by speckle-tracking analysis and Tissue Doppler imaging as early diastolic transmitral inflow velocity/mitral annulus early diastolic velocity [E/e']/LARS.
Results
Invasively measured LVFPs showed a strong correlation with LA stiffness index (Spearman ρ = 0.773, p < 0.0001), as well as with LARS and E/eʹ. Receiver operating characteristic (ROC) curve analysis was used to demonstrate better accuracy performed by LA stiffness index than average E/eʹ, LA volume or LARS alone, in predicting high LVFPs. Guideline-recommended assessment of diastolic function was finally compared to LARS and LA stiffness index performances in an independent population group; we were hence able to obtain a LA stiffness threshold of 0.48 with a positive predictive value of 91.7% and a negative predictive value of 88.9% in identifying patients with high LVFPs.
Conclusions
For the first time, diagnostic performance of LA stiffness index has been investigated in a heterogeneous AHF population, providing correlations with invasively measured LVFPs and comparisons with established diastolic function metrics.
Graphical abstract
Diagnostic work-up of the population and main results of the study. The left atrial stiffness index showed to be a reliable, non-invasive predictor of high filling pressures. Compared to the guideline proposed flowchart for diastolic dysfunction and to left atrial reservoir strain, this novel echocardiographic parameter proved to improve sensitivity and negative predictive value in patients with acute heart failure
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- Titel
- Echocardiographic left atrial stiffness index predicts high left ventricular filling pressures in patients with acute heart failure: an observational study
- Verfasst von
-
Massimiliano Camilli
Ludovica Amore
Federico Ballacci
Giulia Iannaccone
Marco Giuseppe Del Buono
Federica Giordano
Francesca Graziani
Tommaso Sanna
Daniela Pedicino
Francesco Burzotta
Carlo Trani
Gaetano Antonio Lanza
Rocco Antonio Montone
Nadia Aspromonte
Laura Lupi
Marianna Adamo
Filippo Crea
Antonella Lombardo
- Publikationsdatum
- 28.10.2024
- Verlag
- Springer Berlin Heidelberg
- Erschienen in
-
Clinical Research in Cardiology / Ausgabe 10/2025
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692 - DOI
- https://doi.org/10.1007/s00392-024-02562-8
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