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Erschienen in: The International Journal of Cardiovascular Imaging 1/2019

30.07.2018 | Original Paper

Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures

verfasst von: Amita Singh, Diego Medvedofsky, Anuj Mediratta, Bhavna Balaney, Eric Kruse, Boguslawa Ciszek, Atman P. Shah, John E. Blair, Francesco Maffessanti, Karima Addetia, Victor Mor-Avi, Roberto M. Lang

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 1/2019

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Abstract

Echocardiographic assessment of left ventricular (LV) filling pressures is performed using a multi-parametric algorithm. Left atrial (LA) strain was recently found to accurately classify the degree of diastolic dysfunction. We hypothesized that LA strain could be used as a stand-alone marker and sought to identify and test a cutoff, which would accurately detect elevated LV pressures. We studied 76 patients with a spectrum of LV function who underwent same-day echocardiogram and invasive left-heart catheterization. Speckle tracking was used to measure peak LA strain. The protocol involved a retrospective derivation group (N = 26) and an independent prospective validation cohort (N = 50) to derive and then test a peak LA strain cutoff which would identify pre-A-wave LV diastolic pressure > 15 mmHg. The guidelines-based assessment of filling pressures and peak LA strain were compared side-by-side against invasive hemodynamic data. In the derivation cohort, receiver-operating characteristic analysis showed area under curve of 0.76 and a peak LA strain cutoff < 20% was identified as optimal to detect elevated filling pressure. In the validation cohort, peak LA strain demonstrated better agreement with the invasive reference (81%) than the guidelines algorithm (72%). The improvement in classification using LA strain compared to the guidelines was more pronounced in subjects with normal LV function (91% versus 81%). In summary, the use of a peak LA strain to estimate elevated LV filling pressures is more accurate than the current guidelines. Incorporation of LA strain into the non-invasive assessment of LV diastolic function may improve the detection of elevated filling pressures.
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Metadaten
Titel
Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures
verfasst von
Amita Singh
Diego Medvedofsky
Anuj Mediratta
Bhavna Balaney
Eric Kruse
Boguslawa Ciszek
Atman P. Shah
John E. Blair
Francesco Maffessanti
Karima Addetia
Victor Mor-Avi
Roberto M. Lang
Publikationsdatum
30.07.2018
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 1/2019
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-018-1425-y

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