Correlation of Left Atrial Strain and Doppler Measurements with Invasive Measurement of Left Ventricular End-Diastolic Pressure in Patients Stratified for Different Values of Ejection Fraction

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 33; no. 3; pp. 398 - 405
• Main Authors: Cameli, Matteo, Sparla, Stefania, Losito, Maurizio, Righini, Francesca M., Menci, Daniele, Lisi, Matteo, D'Ascenzi, Flavio, Focardi, Marta, Favilli, Roberto, Pierli, Carlo, Fineschi, Massimo, Mondillo, Sergio
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.03.2016
• Subjects: Aged; atrium; Doppler tissue imaging; Echocardiography, Doppler - methods; Elastic Modulus; Elasticity Imaging Techniques - methods; Female; filling pressures; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Humans; Image Interpretation, Computer-Assisted - methods; left ventricular end-diastolic pressure (LVEDP); left ventricular filling pressures; Male; preload; Reproducibility of Results; Sensitivity and Specificity; speckle tracking; Statistics as Topic; strain; Stroke Volume; Vascular Stiffness; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Pressure; filling pressures; speckle tracking; strain; Doppler tissue imaging; left ventricular end-diastolic pressure (LVEDP); atrium; preload; left ventricular filling pressures
• DOI: 10.1111/echo.13094
• ISSN: 0742-2822

Background This study aimed at exploring the correlation of left atrial longitudinal function by speckle tracking echocardiography (left atrial strain) and Doppler measurements (E/E' ratio) with direct measurements of left ventricular (LV) end‐diastolic pressure (LVEDP) in patients stratified for different values of ejection fraction. Methods The study population was 80 stable patients with sinus rhythm undergoing cardiac catheterization. This population was selected in order to have four groups of 20 patients each with different LV ejection fraction (>55%, 45–54%, 30–44%, and <30%). LVEDP was obtained during cardiac catheterization; peak atrial longitudinal strain (PALS) and mean E/E' ratio were measured in all subjects. Results Similar correlations with LVEDP of global PALS and E/E' ratio were recorded in patients with preserved (r = −0.79 vs. r = 0.72, respectively; P < 0.0001 for both) or mildly reduced ejection fraction (r = −0.75 vs. r = 0.73, respectively; P < 0.0001 for both). A closer correlation of global PALS compared to E/E' ratio was evident in patients with moderate (r = −0.78 P < 0.0001; vs. r = 0.47 P = 0.01, respectively) and severe reduction (r = −0.74 P < 0.0001; vs. r = 0.19 ns, respectively) of LV ejection fraction. In multivariate analysis of all measurements, global PALS emerged as a determinant of the LVEDP, independent on other confounding factors and, with the cutoff value of 18.0% presented the best diagnostic accuracy to predict a LVDP above 12 mmHg (AUC 0.87). Conclusions In patients with preserved or mildly reduced LV ejection fraction, global PALS and mean E/E' ratio presented good correlations with LVEDP. In patients with moderate or severe reduction of ejection fraction, E/E' ratio correlated poorly with invasively obtained LV filling pressures. Global PALS provided an overall better estimation of LV filling pressures.