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Association between left atrial strain and left ventricular diastolic function in patients with acute coronary syndrome

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Abstract

Background

Left ventricular diastolic function is an important prognostic marker in acute coronary syndrome. However, classification of the dysfunction grade using isolated echocardiographic parameters remains difficult. Therefore, it is necessary to combine multiple data in diagnostic algorithms. The purpose of this study was to evaluate the capacity of left atrial strain (LAS) components to classify left ventricular diastolic dysfunction (DD) grade.

Methods

Cross-sectional study with 109 consecutive patients admitted to the emergency room with acute coronary syndrome. Patients were referred for echocardiographic evaluation within 72 h. Mean values of LAS, corresponding to three phases of atrial function (reservoir, conduit and contraction), were obtained by speckle-tracking echocardiography. Patients were divided according to the diastolic dysfunction grade for later association with the LAS.

Results

The three LAS components showed moderate correlation with most diastolic variables (left atrial volume index, E/e′ ratio and e′ wave). In addition, there was related reduction of the LAS, which was inversely proportional to the DD grade (p < 0.05). LAS was effective for the identification of patients with DD grade III [area under the curve (AUC) for the reservoir = 0.99; conduit AUC = 0.89; contraction AUC = 0.99) and also those with DD grade II or III (reservoir AUC = 0.94; conduit AUC = 0.92; contraction AUC = 0.80].

Conclusions

LAS alone presented excellent capacity to classify DD in patients with acute coronary syndrome and may represent an additional tool for this purpose.

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Acknowledgements

We would like to thank the Statistics and Epidemiology Laboratory of Dante Pazzanese Institute of Cardiology, especially João Ítalo Dias França MSc, a professional who contributed significantly to the analyses performed in this study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Dante Pazzanese Institute of Cardiology, Dr. Dante Pazzanese Avenue, 500 Vila Mariana, São Paulo, SP, 04012-909, Brazil

    Rafael Modesto Fernandes, David Le Bihan, Andrea A. Vilela, Rodrigo B. M. Barretto, Elizabete S. Santos, Jorge E. Assef, Simone Rolim Fontes Pedra, Amanda G. M. R. Sousa & Ari Timerman

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  1. Rafael Modesto Fernandes
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  2. David Le Bihan
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Correspondence to Rafael Modesto Fernandes.

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Conflict of interest

David Le Bihan and Rodrigo Barretto have been granted speaker honoraria from GE Vingmed (Brazil). Rafael M. Fernandes, Andrea A. Vilela, Elizabete S. Santos, Jorge E. Assef, Simone Rolim Fontes Pedra, Amanda G.M.R Sousa and Ari Timerman have no conflicts of interest.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions. Informed consent was obtained from all patients for being included in the study.

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Fernandes, R.M., Le Bihan, D., Vilela, A.A. et al. Association between left atrial strain and left ventricular diastolic function in patients with acute coronary syndrome. J Echocardiogr 17, 138–146 (2019). https://doi.org/10.1007/s12574-018-0403-7

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  • DOI: https://doi.org/10.1007/s12574-018-0403-7

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