Daniel A Morris1, Evgeny Belyavskiy2, Radhakrishnan Aravind-Kumar2, Martin Kropf2, Athanasios Frydas3, Kerstin Braunauer2, Esteban Marquez4, Maximilian Krisper2, Ruhdja Lindhorst2, Engin Osmanoglou5, Leif-Hendrik Boldt2, Florian Blaschke2, Wilhelm Haverkamp2, Carsten Tschöpe3, Frank Edelmann6, Burkert Pieske7, Elisabeth Pieske-Kraigher2. 1. Department of Internal Medicine and Cardiology, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany. Electronic address: daniel-armando.morris@charite.de. 2. Department of Internal Medicine and Cardiology, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany. 3. Department of Internal Medicine and Cardiology, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany. 4. Private Clinic of Radiology (Q-Diagnostica-Scanner Murcia), Murcia, Spain. 5. Department of Internal Medicine and Cardiology, Meoclinic, Berlin, Germany. 6. Department of Internal Medicine and Cardiology, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany; German Center for Cardiovascular Research (DZHK), partner site, Berlin, Germany. 7. Department of Internal Medicine and Cardiology, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany; Department of Internal Medicine and Cardiology, Meoclinic, Berlin, Germany; German Heart Institute, Berlin, Germany.
Abstract
OBJECTIVES: The purpose of this study was to analyze the potential usefulness and clinical relevance of adding left atrial (LA) strain to left atrial volume index (LAVI) in the detection of left ventricular diastolic dysfunction (LVDD) in patients with preserved left ventricular ejection fraction (LVEF). BACKGROUND: Recent studies have suggested that LA strain could be of use in the evaluation of LVDD. However, the potential utility and clinical significance of adding LA strain to LAVI in the detection of LVDD remains uncertain. METHODS: Using 2-dimensional speckle-tracking echocardiography, we analyzed a population of 517 patients in sinus rhythm at risk for LVDD such as those with arterial hypertension, diabetes mellitus, or history of coronary artery disease and preserved LVEF. RESULTS: In patients with LV diastolic alterations and estimated elevated LV filling pressures, the rate of abnormal LA strain was significantly higher than an abnormal LAVI (62.4% vs. 33.6%, p < 0.01). In line with this, in patients with normal LAVI, high rates of LV diastolic alterations and abnormal LA strain were present (rates 80% and 29.4%, respectively). In agreement with these findings, adding LA strain to LAVI in the current evaluation of LVDD increased significantly the rate of detection of LVDD (relative and absolute increase 73.3% and 9.9%; rate of detection of LVDD: from 13.5% to 23.4%; p < 0.01). Regarding the clinical relevance of these findings, an abnormal LA strain (i.e., <23%) was significantly associated with worse New York Heart Association functional class, even when LAVI was normal. Moreover, in a retrospective post hoc analysis an abnormal LA strain had a significant association with the risk of heart failure hospitalization at 2 years (odds ratio: 6.6 [95% confidence interval: 2.6 to 16.6]) even adjusting this analysis for age and sex and in patients with normal LAVI. CONCLUSIONS: The findings from this study provide important insights regarding the potential usefulness and clinical relevance of adding LA strain to LAVI in the detection of LVDD in patients with preserved LVEF.
OBJECTIVES: The purpose of this study was to analyze the potential usefulness and clinical relevance of adding left atrial (LA) strain to left atrial volume index (LAVI) in the detection of left ventricular diastolic dysfunction (LVDD) in patients with preserved left ventricular ejection fraction (LVEF). BACKGROUND: Recent studies have suggested that LA strain could be of use in the evaluation of LVDD. However, the potential utility and clinical significance of adding LA strain to LAVI in the detection of LVDD remains uncertain. METHODS: Using 2-dimensional speckle-tracking echocardiography, we analyzed a population of 517 patients in sinus rhythm at risk for LVDD such as those with arterial hypertension, diabetes mellitus, or history of coronary artery disease and preserved LVEF. RESULTS: In patients with LV diastolic alterations and estimated elevated LV filling pressures, the rate of abnormal LA strain was significantly higher than an abnormal LAVI (62.4% vs. 33.6%, p < 0.01). In line with this, in patients with normal LAVI, high rates of LV diastolic alterations and abnormal LA strain were present (rates 80% and 29.4%, respectively). In agreement with these findings, adding LA strain to LAVI in the current evaluation of LVDD increased significantly the rate of detection of LVDD (relative and absolute increase 73.3% and 9.9%; rate of detection of LVDD: from 13.5% to 23.4%; p < 0.01). Regarding the clinical relevance of these findings, an abnormal LA strain (i.e., <23%) was significantly associated with worse New York Heart Association functional class, even when LAVI was normal. Moreover, in a retrospective post hoc analysis an abnormal LA strain had a significant association with the risk of heart failure hospitalization at 2 years (odds ratio: 6.6 [95% confidence interval: 2.6 to 16.6]) even adjusting this analysis for age and sex and in patients with normal LAVI. CONCLUSIONS: The findings from this study provide important insights regarding the potential usefulness and clinical relevance of adding LA strain to LAVI in the detection of LVDD in patients with preserved LVEF.
Authors: Francesco Bandera; Anita Mollo; Matteo Frigelli; Giulia Guglielmi; Nicoletta Ventrella; Maria Concetta Pastore; Matteo Cameli; Marco Guazzi Journal: Front Cardiovasc Med Date: 2022-01-13
Authors: Angel M Alonso Gómez; Lucas Tojal Sierra; Noris Mora Mora; Estefanía Toledo; Alvaro Alonso; María Garrido Uriarte; Carolina Sorto Sanchez; María P Portillo; Luis López Rodriguez; Elena Escribano Arellano; Helmut Schröder; Jordi Salas-Salvadó Journal: Int J Cardiol Date: 2021-12-08 Impact factor: 4.164
Authors: Rafael Modesto Fernandes; David Le Bihan; Andrea A Vilela; Rodrigo B M Barretto; Elizabete S Santos; Jorge E Assef; Simone Rolim Fontes Pedra; Amanda G M R Sousa; Ari Timerman Journal: J Echocardiogr Date: 2018-10-31