Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure

• Published in: European heart journal cardiovascular imaging Vol. 23; no. 1; pp. 61 - 70
• Main Authors: Inoue, Katsuji, Khan, Faraz H, Remme, Espen W, Ohte, Nobuyuki, García-Izquierdo, Eusebio, Chetrit, Michael, Moñivas-Palomero, Vanessa, Mingo-Santos, Susana, Andersen, Øyvind S, Gude, Einar, Andreassen, Arne K, Wang, Tom Kai Ming, Kikuchi, Shohei, Stugaard, Marie, Ha, Jong-Won, Klein, Allan L, Nagueh, Sherif F, Smiseth, Otto A
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 18.12.2021
• Subjects: Echocardiography; Heart Atria - diagnostic imaging; Humans; Stroke Volume; Systole; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Function, Left; diastolic dysfunction; heart failure; catheterization; left ventricular filling pressure; left atrial strain
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jeaa415

Abstract Aims The aim of this study is to investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as non-invasive markers of left ventricular (LV) filling pressure. Methods and results In a multicentre study of 322 patients with cardiovascular disease of different aetiologies, LA strain and other echocardiographic parameters were compared with invasively measured LV filling pressure. The strongest determinants of LA reservoir and pump strain were LV global longitudinal strain (GLS) (r-values 0.64 and 0.51, respectively) and LV filling pressure (r-values −0.52 and −0.57, respectively). Left atrial volume was another independent, but weaker determinant of both LA strains. For both LA strains, association with LV filling pressure was strongest in patients with reduced LV ejection fraction. Left atrial reservoir strain <18% and LA pump strain <8% predicted elevated LV filling pressure better (P < 0.05) than LA volume and conventional Doppler parameters. Accuracy to identify elevated LV filling pressure was 75% for LA reservoir strain alone and 72% for pump strain alone. When combined with conventional parameters, accuracy was 82% for both LA strains. In patients with normal LV systolic function by GLS, LA pump strain >14% identified normal LV filling pressure with 92% accuracy. Conclusion Left atrial reservoir and pump strain are determined predominantly by LV GLS and filling pressure. Accuracy of LA strains to identify elevated LV filling pressure was best in patients with reduced LV systolic function. High values of LA pump strain, however, identified normal LV filling pressure with good accuracy in patients with normal systolic function. Graphical Abstract Determinants and clinical application of LA reservoir and pump strain: Panel A: Apical 4-chamber image with colour coded region of interest for LA strain and the LA strain trace. Panel B: Relationship between LA reservoir strain and LV filling pressure in the total population. Panel C: Left atrial pump strain > 14% identifies normal LV filling pressure. Panel D: ROC curves for classification of LV filling pressure as normal or elevated. For comparison, curves are from the 235 patients where pump strain could be assessed. Panel E: Illustrates how LA strain may be incorporated in the decision algorithm for evaluation of LV filling pressure from the 2016 ASE/EACVI guideline (2).