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

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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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Abbreviations

AUC:

Area under curve

EDP:

End-diastolic pressure

EF:

Ejection fraction

LA:

Left atrial

LAVi:

Left atrial volume index

LV:

Left ventricular

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver-operating characteristic

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Acknowledgements

AS was supported by funding from the NIH T32 Training Grant (#5T32HL7381).

Author information

Correspondence to Victor Mor-Avi.

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The authors have no relevant financial disclosures or conflicts of interest.

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Singh, A., Medvedofsky, D., Mediratta, A. et al. Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures. Int J Cardiovasc Imaging 35, 23–32 (2019). https://doi.org/10.1007/s10554-018-1425-y

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Keywords

  • Left atrium
  • Filling pressure
  • Diastolic function