Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure

Katsuji Inoue, Faraz H. Khan, Espen W. Remme, Nobuyuki Ohte, Eusebio García-Izquierdo, Michael Chetrit, Vanessa Moñivas-Palomero, Susana Mingo-Santos, Øyvind S. Andersen, Einar Gude, Arne K. Andreassen, Tom Kai Ming Wang, Shohei Kikuchi, Marie Stugaard, Jong Won Ha, Allan L. Klein, Sherif F. Nagueh, Otto A. Smiseth

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Aims: The aim of this study is to investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as non-invasive markers of left ventricular (LV) filling pressure. Methods and results: In a multicentre study of 322 patients with cardiovascular disease of different aetiologies, LA strain and other echocardiographic parameters were compared with invasively measured LV filling pressure. The strongest determinants of LA reservoir and pump strain were LV global longitudinal strain (GLS) (r-values 0.64 and 0.51, respectively) and LV filling pressure (r-values -0.52 and -0.57, respectively). Left atrial volume was another independent, but weaker determinant of both LA strains. For both LA strains, association with LV filling pressure was strongest in patients with reduced LV ejection fraction. Left atrial reservoir strain <18% and LA pump strain <8% predicted elevated LV filling pressure better (P < 0.05) than LA volume and conventional Doppler parameters. Accuracy to identify elevated LV filling pressure was 75% for LA reservoir strain alone and 72% for pump strain alone. When combined with conventional parameters, accuracy was 82% for both LA strains. In patients with normal LV systolic function by GLS, LA pump strain >14% identified normal LV filling pressure with 92% accuracy. Conclusion: Left atrial reservoir and pump strain are determined predominantly by LV GLS and filling pressure. Accuracy of LA strains to identify elevated LV filling pressure was best in patients with reduced LV systolic function. High values of LA pump strain, however, identified normal LV filling pressure with good accuracy in patients with normal systolic function.

Original languageEnglish (US)
Pages (from-to)61-70
Number of pages10
JournalEuropean Heart Journal Cardiovascular Imaging
Volume23
Issue number1
DOIs
StatePublished - Jan 1 2022

Keywords

  • catheterization
  • diastolic dysfunction
  • heart failure
  • left atrial strain
  • left ventricular filling pressure

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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