Abstract 12421: Single Beat Simultaneous Left Atrioventricular Strain-Volume Analysis Using Speckle Tracking Echocardiography

Abstract

Introduction: Assessment of cardiac mechanics in relation to left atrial (LA) and ventricular (LV) structural (shape and volume) changes represent a foundation for assessing cardiac remodeling in heart failure (HF) patients. We tested the feasibility of assessing simultaneous LA and LV volumes and deformation within an index cardiac cycle as a marker of total left heart structural and functional remodeling in HF. Methods: Echocardiography was performed in total 101 patients, which included 77 patients with HF (50 had normal EF (HFNEF) and 27 had reduced EF (HFREF)) and 24 young subjects with no structural heart disease (controls) (table 1). Two-dimensional speckle tracking was performed in apical 2- and 4- chamber views for simultaneous measurement of LV and LA volumes and deformation. Peak longitudinal average atrio-ventricular strain (AVS) and early diastolic strain rate (AVSR-E), in addition to the total left heart volume (TLV) during LV systole and diastole (TLVsystole, TLVdiastole), were measured. Occurrence of major adverse cardiac events (MACE) was defined during follow up. Results: In comparison with younger controls, patient with HF showed higher TLV and nearly 50% reduction in AVS and AVSR-E (table 1). These differences persisted even after adjusting for age. During a median follow up of 7 months, MACE occurred in 15 patients (5 hospitalization for heart failure, 1 cerebrovascular stroke, and 9 cardiac deaths). AVS and AVSR-E were predictors for MACE after adjusting for age (HR=0.9, 95% CI: 0.81 to 0.99, p=0.038; HR= 0.14, 95% CI: 0.02 to 0.89, p=0.037; respectively). AVS and AVSR-E had similar diagnostic values in predicting MACE (AUC= 0.77 and 0.79; p=0.001 and <0.001 respectively), with higher event free survival seen for AV-S>14.5%, and AVSR-E>0.92 s-1 (Figure 1). Conclusion: Single beat combined assessments of LA-LV strain and strain rates may be useful integrated markers of total left heart function.