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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).

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Authors and Affiliations

  1. University of Chicago Medical Center, Chicago, IL, USA

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

  2. University of Wisconsin-Madison, Madison, WI, USA

    Amita Singh

  3. North Shore University Hospital, Manhasset, NY, USA

    Anuj Mediratta

  4. Università della Svizzera Italiana, Lugano, Switzerland

    Francesco Maffessanti

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  1. Amita Singh
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  2. Diego Medvedofsky
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  4. Bhavna Balaney
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  5. Eric Kruse
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  7. Atman P. Shah
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  9. Francesco Maffessanti
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  10. Karima Addetia
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  11. Victor Mor-Avi
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Correspondence to Victor Mor-Avi.

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Video 1

. Speckle tracking analysis of left atrial strain. After left atrial boundary is traced manually (left), it is automatically tracked throughout the cardiac cycle, and longitudinal strain is calculated for each consecutive frame in 6 atrial segments. Strain over time is displayed as 6 time curves, color coded the same way as the segmental boundaries to facilitate evaluation of the boundary tracking in each segment (top right). (MOV 2988 KB)

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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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