Abstract
This study aimed to assess the relationship between different LA strain components and PCWP as well as to the relationship with other established methods. We studied 144 symptomatic patients, age 63 ± 14 years, 54 males, using conventional transthoracic echocardiography protocols, including LA and LV myocardial deformation from speckle tracking technique investigations along with simultaneous right heart catheterization (RHC) using established techniques. From RHC, pulmonary artery pressure (PAP), and pulmonary capillary wedge pressure (PCWP) were measured and pulmonary vascular resistance (PVR) calculated. LA strain rate during atrial contraction (LASRa) was the strongest correlate with PCWP (r2 = − 0.40, p < 0.001), over and above both LASR during LV systole (LASRs) and LA longitudinal strain during ventricular systole (LASs) (r2 = 0.21 and 0.19, respectively, p < 0.001 for both). The correlation between LASRa and PCWP was stronger in patients with post-capillary PH compared to pre-capillary PH (r2 = 0.21 vs. r2 = 0.02, respectively). The strongest relationship between LASRa and PCWP was in patients with enlarged LA volume > 34 ml/m2 (r2 = 0.60, p < 0.001). In all patients LASRa < = 0.9 1/s was 88% accurate in predicting LA pressure > 15 mmHg which was superior to recently proposed uni- and multi-variable models. LASR during atrial contraction is the strongest predictor of PCWP, particularly in patients with post-capillary PH and with dilated LA cavity. Furthermore, it proved superior to recently proposed uni- and multi-variable based algorithms. Its close relationship with LV strain rate counterpart reflects important left heart chamber interaction in patients with raised LA pressure.
Highlights
Left atrial pressure (LAP) changes is a corner stone explanation of symptoms in cardiac patients
The findings of this study are summarized as follows: (1) Among the LA strain and strain rate measurements, strain rate during atrial contraction was the best accurate component of LA deformation measurements that correlated with pulmonary capillary wedge pressure (PCWP); (2) Such relationship was strong in patients with post-CPH and with enlarged LA, volume > 34 ml/m2
The findings of this study were not met with a surprise since the components of the strongest relationship, we found, between LA structure and function and PCWP represent a continuum of blood flow and pressure
Summary
Left atrial pressure (LAP) changes is a corner stone explanation of symptoms in cardiac patients. In the absence of significant mitral valve disease, raised LAP is mainly due to left ventricular (LV) disease and raised diastolic pressures. Assessment of LAP has historically been an invasive investigation with catheter tip manometers placed in the peripheral. Myocardial speckle strain LA function has recently developed [8]. Reduced peak longitudinal LA strain has been shown to correlate with raised LA pressures [9], despite potentially been influenced by a number of other co-factors. The International Journal of Cardiovascular Imaging (2021) 37:1529–1538. The aim of this study was to investigate the best accurate component of LA deformation function that predicts raised LA pressure and its relationship with its LV counterpart Reduced peak longitudinal LA strain has been shown to correlate with raised LA pressures [9], despite potentially been influenced by a number of other co-factors. [10]
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