Estimating elevated left ventricular end-diastolic pressure by automated left atrial strain analysis in patients with aortic stenosis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background The evaluation of left ventricular (LV) filling pressure using left atrial (LA) reservoir strain on echocardiography has demonstrated high feasibility and good accuracy. Other LA strain components, such as conduit and booster strain, may show additional diagnostic value for the detection of elevated LV filling pressure. The current automated LA strain analysis has the potential to predict elevated LV end-diastolic pressure (LVEDP) using all LA strain components. Aims The aim of this study is to assess the diagnostic accuracy of automated LA strain for the detection of elevated LVEDP as measured by invasive catherization in comparison to conventional echocardiographic parameters. Methods We included the patients with aortic stenosis (AS) who underwent echocardiography within 48 hours prior to transcatheter aortic valve implantation and had LVEDP measured by catherization during procedure. Patients with atrial fibrillation, previous mitral valve surgery, and mitral stenosis were excluded. LA strain components were measured from apical 4-chamber view using commercial software (AutoStrain LA, Tomtec). (Abstract Picture 1) Elevated LVEDP was defined as a threshold of LVEDP ≥16 mmHg. The cut-off value of conventional echocardiographic parameters for detection of elevated LVEDP were determined according to current guidelines. Results A total of 95 patients (84 ± 7 years, 53% men) were included in this study. Elevated LVEDP was shown in 42 patients. The sensitivity and diagnostic accuracy for the detection of elevated LVEDP on automated LA strain were the best among conventional echocardiographic parameters, including peak reservoir LA strain. (Abstract picture 2) The diagnostic accuracy of automated LA strain was similar between in patients with LV ejection fraction ≥ 50% and those with LV ejection fraction <50% (82% vs 86%). Conclusions Automated LA strain analysis demonstrated superior diagnostic accuracy for the detection of elevated LVEDP in patients with AS. It might thus serve as a non-invasive and accurate alternative method for assessment of elevated LV filling pressure.