Left atrial strain improves estimation of filling pressures in heart failure

a simultaneous echocardiographic and invasive haemodynamic study

Anders Lundberg, Jonas Johnson, Camilla Hage, Magnus Bäck, B. Merkely, Ashwin Venkateshvaran, Lars H. Lund, Anikó Ilona Nagy, Aristomenis Manouras

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Aims: Left ventricular diastolic pressure estimation is essential for characterization of heart failure (HF). Patients with normal resting left atrial (LA) pressures (LAP), but steep LAP elevation on exertion, pose a particular diagnostic challenge. Current recommendations on echocardiographic LAP estimation have limited accuracy. Our aim was to investigate whether LA mechanical alterations assessed by LA strain (LA-GS) can contribute to non-invasive LAP diagnostics. Methods and results: Simultaneous echocardiographic and right heart catheterization (RHC) data at rest and during exercise was analyzed in 164 prospectively enrolled patients, referred for RHC due to HF symptoms. 56% had preserved ejection fraction (pEF). At rest, 97 patients displayed elevated mean pulmonary arterial wedge pressure (PAWPM); further 32 patients had normal resting, but elevated PAWPM during exercise. LA-GS demonstrated a stronger relationship with resting PAWPM (r = − 0.61, p < 0.001) than any of the indices (E/e′, LAVi, TRVmax) incorporated in the currently recommended diagnostic algorithm. The diagnostic ability of LA-GS for detecting elevated resting PAWPM (AUC: 0.80, p < 0.001) outperformed that of the recommended algorithm (AUC: 0.69). Importantly, resting LA-GS performed even better in identifying patients with pathological PAWPM either at rest or during stress (AUC: 0.90, p < 0.001), whereas the diagnostic potential of the current algorithm was modest and limited to pEF patients (AUC = 0.72). Finally, among the non-invasive indices, LA-GS entailed the strongest prognostic value for death or heart transplantation (OR: 2.7; p < 0.05). Conclusion: LA-GS comprises a robust method for PAWPM assessment at rest. More importantly, it reliably discerns pathological PAWPM rise on exertion despite normal resting pressures.

Original languageEnglish
JournalClinical Research in Cardiology
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Heart Failure
Hemodynamics
Area Under Curve
Pressure
Cardiac Catheterization
Exercise
Pulmonary Wedge Pressure
Atrial Pressure
Patient Rights
Ventricular Pressure
Heart Transplantation
Arterial Pressure
Blood Pressure

Keywords

  • Diastolic pressures
  • Exercise
  • Invasive
  • Left atrial strain
  • Non-invasive

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Left atrial strain improves estimation of filling pressures in heart failure : a simultaneous echocardiographic and invasive haemodynamic study. / Lundberg, Anders; Johnson, Jonas; Hage, Camilla; Bäck, Magnus; Merkely, B.; Venkateshvaran, Ashwin; Lund, Lars H.; Nagy, Anikó Ilona; Manouras, Aristomenis.

In: Clinical Research in Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Lundberg, Anders ; Johnson, Jonas ; Hage, Camilla ; Bäck, Magnus ; Merkely, B. ; Venkateshvaran, Ashwin ; Lund, Lars H. ; Nagy, Anikó Ilona ; Manouras, Aristomenis. / Left atrial strain improves estimation of filling pressures in heart failure : a simultaneous echocardiographic and invasive haemodynamic study. In: Clinical Research in Cardiology. 2018.
@article{6c34728ec8694894a48a34361280894e,
title = "Left atrial strain improves estimation of filling pressures in heart failure: a simultaneous echocardiographic and invasive haemodynamic study",
abstract = "Aims: Left ventricular diastolic pressure estimation is essential for characterization of heart failure (HF). Patients with normal resting left atrial (LA) pressures (LAP), but steep LAP elevation on exertion, pose a particular diagnostic challenge. Current recommendations on echocardiographic LAP estimation have limited accuracy. Our aim was to investigate whether LA mechanical alterations assessed by LA strain (LA-GS) can contribute to non-invasive LAP diagnostics. Methods and results: Simultaneous echocardiographic and right heart catheterization (RHC) data at rest and during exercise was analyzed in 164 prospectively enrolled patients, referred for RHC due to HF symptoms. 56{\%} had preserved ejection fraction (pEF). At rest, 97 patients displayed elevated mean pulmonary arterial wedge pressure (PAWPM); further 32 patients had normal resting, but elevated PAWPM during exercise. LA-GS demonstrated a stronger relationship with resting PAWPM (r = − 0.61, p < 0.001) than any of the indices (E/e′, LAVi, TRVmax) incorporated in the currently recommended diagnostic algorithm. The diagnostic ability of LA-GS for detecting elevated resting PAWPM (AUC: 0.80, p < 0.001) outperformed that of the recommended algorithm (AUC: 0.69). Importantly, resting LA-GS performed even better in identifying patients with pathological PAWPM either at rest or during stress (AUC: 0.90, p < 0.001), whereas the diagnostic potential of the current algorithm was modest and limited to pEF patients (AUC = 0.72). Finally, among the non-invasive indices, LA-GS entailed the strongest prognostic value for death or heart transplantation (OR: 2.7; p < 0.05). Conclusion: LA-GS comprises a robust method for PAWPM assessment at rest. More importantly, it reliably discerns pathological PAWPM rise on exertion despite normal resting pressures.",
keywords = "Diastolic pressures, Exercise, Invasive, Left atrial strain, Non-invasive",
author = "Anders Lundberg and Jonas Johnson and Camilla Hage and Magnus B{\"a}ck and B. Merkely and Ashwin Venkateshvaran and Lund, {Lars H.} and Nagy, {Anik{\'o} Ilona} and Aristomenis Manouras",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s00392-018-1399-8",
language = "English",
journal = "Clinical Research in Cardiology",
issn = "1861-0684",
publisher = "D. Steinkopff-Verlag",

}

TY - JOUR

T1 - Left atrial strain improves estimation of filling pressures in heart failure

T2 - a simultaneous echocardiographic and invasive haemodynamic study

AU - Lundberg, Anders

AU - Johnson, Jonas

AU - Hage, Camilla

AU - Bäck, Magnus

AU - Merkely, B.

AU - Venkateshvaran, Ashwin

AU - Lund, Lars H.

AU - Nagy, Anikó Ilona

AU - Manouras, Aristomenis

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Aims: Left ventricular diastolic pressure estimation is essential for characterization of heart failure (HF). Patients with normal resting left atrial (LA) pressures (LAP), but steep LAP elevation on exertion, pose a particular diagnostic challenge. Current recommendations on echocardiographic LAP estimation have limited accuracy. Our aim was to investigate whether LA mechanical alterations assessed by LA strain (LA-GS) can contribute to non-invasive LAP diagnostics. Methods and results: Simultaneous echocardiographic and right heart catheterization (RHC) data at rest and during exercise was analyzed in 164 prospectively enrolled patients, referred for RHC due to HF symptoms. 56% had preserved ejection fraction (pEF). At rest, 97 patients displayed elevated mean pulmonary arterial wedge pressure (PAWPM); further 32 patients had normal resting, but elevated PAWPM during exercise. LA-GS demonstrated a stronger relationship with resting PAWPM (r = − 0.61, p < 0.001) than any of the indices (E/e′, LAVi, TRVmax) incorporated in the currently recommended diagnostic algorithm. The diagnostic ability of LA-GS for detecting elevated resting PAWPM (AUC: 0.80, p < 0.001) outperformed that of the recommended algorithm (AUC: 0.69). Importantly, resting LA-GS performed even better in identifying patients with pathological PAWPM either at rest or during stress (AUC: 0.90, p < 0.001), whereas the diagnostic potential of the current algorithm was modest and limited to pEF patients (AUC = 0.72). Finally, among the non-invasive indices, LA-GS entailed the strongest prognostic value for death or heart transplantation (OR: 2.7; p < 0.05). Conclusion: LA-GS comprises a robust method for PAWPM assessment at rest. More importantly, it reliably discerns pathological PAWPM rise on exertion despite normal resting pressures.

AB - Aims: Left ventricular diastolic pressure estimation is essential for characterization of heart failure (HF). Patients with normal resting left atrial (LA) pressures (LAP), but steep LAP elevation on exertion, pose a particular diagnostic challenge. Current recommendations on echocardiographic LAP estimation have limited accuracy. Our aim was to investigate whether LA mechanical alterations assessed by LA strain (LA-GS) can contribute to non-invasive LAP diagnostics. Methods and results: Simultaneous echocardiographic and right heart catheterization (RHC) data at rest and during exercise was analyzed in 164 prospectively enrolled patients, referred for RHC due to HF symptoms. 56% had preserved ejection fraction (pEF). At rest, 97 patients displayed elevated mean pulmonary arterial wedge pressure (PAWPM); further 32 patients had normal resting, but elevated PAWPM during exercise. LA-GS demonstrated a stronger relationship with resting PAWPM (r = − 0.61, p < 0.001) than any of the indices (E/e′, LAVi, TRVmax) incorporated in the currently recommended diagnostic algorithm. The diagnostic ability of LA-GS for detecting elevated resting PAWPM (AUC: 0.80, p < 0.001) outperformed that of the recommended algorithm (AUC: 0.69). Importantly, resting LA-GS performed even better in identifying patients with pathological PAWPM either at rest or during stress (AUC: 0.90, p < 0.001), whereas the diagnostic potential of the current algorithm was modest and limited to pEF patients (AUC = 0.72). Finally, among the non-invasive indices, LA-GS entailed the strongest prognostic value for death or heart transplantation (OR: 2.7; p < 0.05). Conclusion: LA-GS comprises a robust method for PAWPM assessment at rest. More importantly, it reliably discerns pathological PAWPM rise on exertion despite normal resting pressures.

KW - Diastolic pressures

KW - Exercise

KW - Invasive

KW - Left atrial strain

KW - Non-invasive

UR - http://www.scopus.com/inward/record.url?scp=85058195463&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058195463&partnerID=8YFLogxK

U2 - 10.1007/s00392-018-1399-8

DO - 10.1007/s00392-018-1399-8

M3 - Article

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

SN - 1861-0684

ER -