Left atrial reservoir strain combined with E/E' as a better single measure to predict elevated LV filling pressures in patients with coronary artery disease
Tóm tắt
The 2016 guidelines for left ventricular diastolic dysfunction diagnosis has been simplified from previous versions; however, multiparametric diagnosis approach still exists indeterminate left ventricular diastolic dysfunction category. Left atrial (LA) strain was recently found useful to predict elevated left ventricular (LV) filling pressures noninvasively. This study aimed to (1) analyze the diagnostic value of LA strain for noninvasive assessment of LV filling pressures in patients with stable coronary artery disease (CAD) with preserved LV ejection fraction (LVEF), using invasive hemodynamic assessment as the gold standard, and (2) explore whether LA strain combined with conventional diastolic parameters could detect elevated LV filling pressures alone. Sixty-four patients with stable CAD having LVEF > 50% and 30 healthy controls were enrolled. Two-dimensional speckle-tracking echocardiography was used to measure LA strain during the reservoir (LASr), conduit, and contraction phases. LV end-diastolic pressure (LVEDP), as a surrogate for LV filling pressures, was invasively obtained by left heart catheterization. Logistic regression was used to calculate the odds ratio to predict LV filling pressures. Pearson’s correlation was used to analyze associations between echocardiographic parameters and LVEDP. The area under the receiver-operating characteristic curve was calculated to determine the capability of the echocardiographic parameters to detect elevated LVEDP. Inter-technique agreement was analyzed by contingency tables and tested by kappa statistics. LASr and the ratio of early-diastolic transmitral flow velocity (E) to tissue Doppler early-diastolic septal mitral annular velocity (E/E′septal) significantly predicted elevated LV filling pressures. LASr was combined with E/E′septal to generate a novel parameter (LASr/E/E′septal). LASr/E/E′septal had the best predictive ability of elevated LV filling pressures. LVEDP was negatively correlated with LASr and LASr/E/E′septal but positively correlated with E/E′septal. The area under the receiver-operating characteristic curve of LASr/E/E′septal was higher than that of LASr alone (0.83 vs. 0.75), better than all conventional LV diastolic parameters. Inter-technique agreement analysis showed that LASr/E/E′septal had good agreement with the invasive LVEDP measurement, better than the 2016 guideline (kappa = 0.63 vs. 0.25). LASr provided additive diagnostic value for the noninvasive assessment of LV filling pressures. LASr/E/E′septal had the potential to be a better single noninvasive index to predict elevated LV filling pressures in patients with stable CAD and preserved LVEF.
Tài liệu tham khảo
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277–314.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22(2):107–33.
Pagliaro BR, Cannata F, Stefanini GG, Bolognese L. Myocardial ischemia and coronary disease in heart failure. Heart Fail Rev. 2019.
Kruszewski K, Scott AE, Barclay JL, Small GR, Croal BL, Moller JE, Oh JK, Hillis GS. Noninvasive assessment of left ventricular filling pressure after acute myocardial infarction: a prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide. Am Heart J. 2010;159(1):47–54.
Detry J-MR. The pathophysiology of myocardial ischaemia. Eur Heart J. 1996;17(suppl_G):48–52.
Prasad SB, See V, Brown P, McKay T, Narayan A, Kovoor P, Thomas L. Impact of duration of ischemia on left ventricular diastolic properties following reperfusion for acute myocardial infarction. Am J Cardiol. 2011;108(3):348–54.
Jarnert C, Edner M, Persson HE. Prognosis in myocardial infarction patients with heart failure and normal or mildly impaired systolic function. Int J Cardiol. 2007;117(2):184–90.
Meta-Analysis Research Group in Echocardiography AMIC, Moller JE, Whalley GA, Dini FL, Doughty RN, Gamble GD, Klein AL, Quintana M, Yu CM. Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: meta-analysis research Group in Echocardiography acute myocardial infarction. Circulation. 2008;117(20):2591–8.
Anavekar NS, Mirza A, Skali H, Plappert T, St John Sutton M, Pfeffer MA, Solomon SD. Survival, ventricular enlargement I: risk assessment in patients with depressed left ventricular function after myocardial infarction using the myocardial performance index--survival and ventricular enlargement (SAVE) experience. J Am Soc Echocardiogr. 2006;19(1):28–33.
Malagoli A, Rossi L, Bursi F, Zanni A, Sticozzi C, Piepoli MF, Villani GQ. Left atrial function predicts cardiovascular events in patients with chronic heart failure with reduced ejection fraction. J Am Soc Echocardiogr. 2019;32(2):248–56.
Triposkiadis F, Pieske B, Butler J, Parissis J, Giamouzis G, Skoularigis J, Brutsaert D, Boudoulas H. Global left atrial failure in heart failure. Eur J Heart Fail. 2016;18(11):1307–20.
Melenovsky V, Hwang SJ, Redfield MM, Zakeri R, Lin G, Borlaug BA. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail. 2015;8(2):295–303.
Welles CC, Ku IA, Kwan DM, Whooley MA, Schiller NB, Turakhia MP. Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the heart and soul study. J Am Coll Cardiol. 2012;59(7):673–80.
Vojtech M, Borlaug BA, Boaz R, Ilan H, Luigi F, Morell CH, Lakatta EG, Najjar SS, Kass DA. Cardiovascular features of heart failure with preserved ejection fraction versus nonfailing hypertensive left ventricular hypertrophy in the urban Baltimore community: the role of atrial remodeling/dysfunction. J Am Coll Cardiol. 2007;49(2):198–207.
Singh A, Medvedofsky D, Mediratta A, Balaney B, Kruse E, Ciszek B, Shah AP, Blair JE, Maffessanti F, Addetia K, et al. Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures. Int J Cardiovasc Imaging. 2019;35(1):23–32.
Reddy YNV, Obokata M, Egbe A, Yang JH, Pislaru S, Lin G, Carter R, Borlaug BA. Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction. Eur J Heart Fail. 2019;7:891–900.
Singh A, Addetia K, Maffessanti F, Mor-Avi V, Lang RM. LA strain for categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging. 2017;10(7):735–43.
Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, Tsang TSM. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol. 2006;47(12):2357–63.
Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, Hahn RT, Han Y, Hung J, Lang RM, et al. Recommendations for noninvasive evaluation of native Valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30(4):303–71.
Caballero L, Kou S, Dulgheru R, Gonjilashvili N, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Gomez de Diego JJ, Oliva MJ, et al. Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE study. Eur Heart J Cardiovasc Imaging. 2015;16(9):1031–41.
Badano LP, Kolias TJ, Muraru D, Abraham TP, Aurigemma G, Edvardsen T, D'Hooge J, Donal E, Fraser AG, Marwick T, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018;19(6):591–600.
Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, Pedri S, Ito Y, Abe Y, Metz S, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr. 2015;28(2):183–93.
Task Force M, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949–3003.
Paraskevaidis IA, Tsiapras DP, Karavolias GK, Cokkinos P, Kremastinos DT. Doppler-derived left ventricular end-diastolic pressure prediction model using the combined analysis of mitral and pulmonary a waves in patients with coronary artery disease and preserved left ventricular systolic function. Am J Cardiol. 2002;90(7):720–4.
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267–315.
Delong ER, Delong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45.
Dogan C, Ozdemir N, Hatipoglu S, Bakal RB, Omaygenc MO, Dindar B, Candan O, Emiroglu MY, Kaymaz C. Relation of left atrial peak systolic strain with left ventricular diastolic dysfunction and brain natriuretic peptide level in patients presenting with ST-elevation myocardial infarction. Cardiovasc Ultrasound. 2013;11:24.
Morris DA, Belyavskiy E, Aravind-Kumar R, Kropf M, Frydas A, Braunauer K, Marquez E, Krisper M, Lindhorst R, Osmanoglou E, et al. Potential usefulness and clinical relevance of adding left atrial strain to left atrial volume index in the detection of left ventricular diastolic dysfunction. JACC Cardiovasc Imaging. 2018;11(10):1405–15.
Santos AB, Kraigher-Krainer E, Gupta DK, Claggett B, Zile MR, Pieske B, Voors AA, Lefkowitz M, Bransford T, Shi V, et al. Impaired left atrial function in heart failure with preserved ejection fraction. Eur J Heart Fail. 2014;16(10):1096–103.
Hoit BD. Left atrial size and function: role in prognosis. J Am Coll Cardiol. 2014;63(6):493–505.
Pessoa-Amorim G, Mancio J, Vouga L, Ribeiro J, Gama V, Bettencourt N, Fontes-Carvalho R. Impaired left atrial strain as a predictor of new-onset atrial fibrillation after aortic valve replacement independently of left atrial size. Rev Esp Cardiol (Engl Ed). 2018;71(6):466–76.
Morris DA, Takeuchi M, Krisper M, Kohncke C, Bekfani T, Carstensen T, Hassfeld S, Dorenkamp M, Otani K, Takigiku K, et al. Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging. 2015;16(4):364–72.
Freed BH, Shah SJ. Stepping Out of the Left Ventricle's Shadow: Time to Focus on the Left Atrium in Heart Failure With Preserved Ejection Fraction. Circ Cardiovasc Imaging. 2017;10(4):e006267.
Santos ABS, Roca GQ, Claggett B, Sweitzer NK, Shah SJ, Anand IS, Fang JC, Zile MR, Pitt B, Solomon SD, et al. Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ Heart Fail. 2016;9(4):e002763.
Rosca M, Lancellotti P, Popescu BA, Pierard LA. Left atrial function: pathophysiology, echocardiographic assessment, and clinical applications. Heart. 2011;97(23):1982–9.
Cameli M, Lisi M, Mondillo S, Padeletti M, Ballo P, Tsioulpas C, Bernazzali S, Maccherini M. Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure. Cardiovasc Ultrasound. 2010;8:14.
Brecht A, Oertelt-Prigione S, Seeland U, Rucke M, Hattasch R, Wagelohner T, Regitz-Zagrosek V, Baumann G, Knebel F, Stangl V. Left atrial function in preclinical diastolic dysfunction: two-dimensional speckle-tracking echocardiography-derived results from the BEFRI trial. J Am Soc Echocardiogr. 2016;29(8):750–8.
Schocken DD, Benjamin EJ, Fonarow GC, Krumholz HM, Levy D, Mensah GA, Narula J, Shor ES, Young JB, Hong Y, et al. Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation. 2008;117(19):2544–65.
Nagueh SF. Non-invasive assessment of left ventricular filling pressure. Eur J Heart Fail. 2018;20(1):38–48.
Wang Y, Li Z, Fei H, Yu Y, Ren S, Lin Q, Li H, Tang Y, Hou Y, Li M. Left atrial strain reproducibility using vendor-dependent and vendor-independent software. Cardiovasc Ultrasound. 2019;17(1):9.
Pathan F, D'Elia N, Nolan MT, Marwick TH, Negishi K. Normal Ranges of Left Atrial Strain by Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr. 2017;30(1):59–70.e8.
Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M, Marino E, Galderisi M. Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound. 2009;7:6.