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Usefulness of the pulmonary venous flow waveform for assessing left atrial stiffness

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Abstract

Purpose

This study investigated the novel non-invasive left atrial (LA) stiffness parameter using pulmonary venous (PV) flow measurements and the clinical usefulness of the novel LA stiffness parameter.

Methods

We retrospectively analyzed 237 patients who underwent right heart catheterization and echocardiography less than one week apart. From the pulmonary artery wedge pressure waveform, the difference between x-descent and v-wave (ΔP) was measured. Using the echocardiographic biplane method of disks, the difference between LA maximum volume and that just before atrial contraction (ΔVMOD) was calculated, and the ΔP/ΔVMOD was calculated as a standard LA stiffness index. From the PV flow waveform, the peak systolic velocity (S), peak diastolic velocity (D), and minimum velocity between them (R) were measured, and S/D, S/R, and D/R were calculated. From the speckle tracking echocardiography-derived time–LA volume curve, the difference between LA maximum volume and that just before atrial contraction (ΔVSTE) was measured. Each patient's prognosis was investigated until three years after echocardiography.

Results

Among the PV flow parameters, D/R was significantly correlated with ΔP (r = 0.62), and the correlation coefficient exceeded that between S/D and ΔP (r =  − 0.39) or S/R and ΔP (r = 0.14). The [D/R]/ΔVSTE was significantly correlated with ΔP/ΔVMOD (r = 0.61). During the follow-up, 37 (17%) composite endpoints occurred. Kaplan–Meier analysis showed that patients with [D/R]/ΔVSTE greater than 0.13 /mL were at higher risk of cardiac events.

Conclusion

The [D/R]/ΔVSTE was useful for assessing LA stiffness non-invasively and might be valuable in the prognostic evaluation of patients with cardiac diseases.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Funding

This study was supported by the Charitable Trust Laboratory Medicine Research Foundation of Japan.

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Authors and Affiliations

  1. Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan

    Takehiro Abe & Michito Murayama

  2. Faculty of Health Sciences, Hokkaido University, Sapporo, Japan

    Kazunori Okada & Sanae Kaga

  3. Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan

    Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama & Hisao Nishino

  4. Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Hiroyuki Aoyagi, Yoji Tamaki, Ko Motoi, Yasuyuki Chiba, Suguru Ishizaka, Shingo Tsujinaga, Hiroyuki Iwano, Kiwamu Kamiya, Toshiyuki Nagai & Toshihisa Anzai

  5. Division of Cardiology, Hakodate Municipal Hospital, Hakodate, Japan

    Hiroyuki Iwano

Authors
  1. Takehiro Abe
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by TA, KO, and MM. The first draft of the manuscript was written by TA and KO, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kazunori Okada.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose for this study.

Ethical approval

This study was approved by the Research Ethics Committee of Hokkaido University Hospital (No. 020-0436).

Consent to participate

As all examinations were performed within the scope of medical care, to obtain informed consent was waived. The objectives and methods of this study were shared with the public both through our institution’s website and on a physical bulletin board; patients who did not wish to participate could request that their data be removed from the study.

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Cite this article

Abe, T., Okada, K., Murayama, M. et al. Usefulness of the pulmonary venous flow waveform for assessing left atrial stiffness. Int J Cardiovasc Imaging 39, 23–34 (2023). https://doi.org/10.1007/s10554-022-02689-7

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  • DOI: https://doi.org/10.1007/s10554-022-02689-7

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