Potential role of left atrial strain in estimation of left atrial pressure in patients with chronic heart failure
Abstract Aims In a large proportion of heart failure with reduced ejection fraction (HFrEF) patients, echocardiographic estimation of left atrial pressure (LAP) is not possible when the ratio of the peak early left ventricular filling velocity over the late filling velocity (E/A ratio) is not availa...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-08-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14372 |
| _version_ | 1797770724375527424 |
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| author | Yaar S. Aga Sabrina Abou Kamar Jie Fen Chin Victor. J. van denBerg Mihai Strachinaru Daniel Bowen Rene Frowijn Martijn K. Akkerhuis Alina A. Constantinescu Victor Umans Marcel L. Geleijnse Eric Boersma Jasper J. Brugts Isabella Kardys Bas M. vanDalen |
| author_facet | Yaar S. Aga Sabrina Abou Kamar Jie Fen Chin Victor. J. van denBerg Mihai Strachinaru Daniel Bowen Rene Frowijn Martijn K. Akkerhuis Alina A. Constantinescu Victor Umans Marcel L. Geleijnse Eric Boersma Jasper J. Brugts Isabella Kardys Bas M. vanDalen |
| author_sort | Yaar S. Aga |
| collection | DOAJ |
| description | Abstract Aims In a large proportion of heart failure with reduced ejection fraction (HFrEF) patients, echocardiographic estimation of left atrial pressure (LAP) is not possible when the ratio of the peak early left ventricular filling velocity over the late filling velocity (E/A ratio) is not available, which may occur due to several potential causes. Left atrial reservoir strain (LASr) is correlated with LV filling pressures and may serve as an alternative parameter in these patients. The aim of this study was to determine whether LASr can be used to estimate LAP in HFrEF patients in whom E/A ratio is not available. Methods and results Echocardiograms of chronic HFrEF patients were analysed and LASr was assessed with speckle tracking echocardiography. LAP was estimated using the current ASE/EACVI algorithm. Patients were divided into those in whom LAP could be estimated using this algorithm (LAPe) and into those in whom this was not possible because E/A ratio was not available (LAPne). We assessed the prognostic value of LASr on the primary endpoint (PEP), which comprised the composite of hospitalization for the management of acute or worsened HF, left ventricular assist device implantation, cardiac transplantation, and cardiovascular death, whichever occurred first in time. We studied 153 patients with a mean age of 58 years of whom 76% men and 82% who were in NYHA class I‐II. A total of 86 were in the LAPe group and 67 in the LAPne group. LASr was significantly lower in the LAPne group as compared with the LAPe group (15.8% vs. 23.8%, P < 0.001). PEP‐free survival at a median follow‐up of 2.5 years was 78% in LAPe versus 51% in LAPne patients. An increase in LASr was significantly associated with a reduced risk of the PEP in LAPne patients (adjusted hazard ratio: 0.91 per %, 95% confidence interval 0.84–0.98). An abnormal LASr (<18%) was associated with a five‐fold increase in reaching the PEP. Conclusions In HFrEF patients in whom echocardiographic estimation of LAP is not possible due to due to unavailability of E/A ratio, assessing LASr potentially carries added clinical and prognostic value. |
| first_indexed | 2024-03-12T21:26:19Z |
| format | Article |
| id | doaj.art-2fdbf1ad7f4641b087e6fc96f4f6196c |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-12T21:26:19Z |
| publishDate | 2023-08-01 |
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| series | ESC Heart Failure |
| spelling | doaj.art-2fdbf1ad7f4641b087e6fc96f4f6196c2023-07-28T06:30:48ZengWileyESC Heart Failure2055-58222023-08-011042345235310.1002/ehf2.14372Potential role of left atrial strain in estimation of left atrial pressure in patients with chronic heart failureYaar S. Aga0Sabrina Abou Kamar1Jie Fen Chin2Victor. J. van denBerg3Mihai Strachinaru4Daniel Bowen5Rene Frowijn6Martijn K. Akkerhuis7Alina A. Constantinescu8Victor Umans9Marcel L. Geleijnse10Eric Boersma11Jasper J. Brugts12Isabella Kardys13Bas M. vanDalen14Department of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Thoraxcenter Erasmus University Medical Center Rotterdam The NetherlandsAbstract Aims In a large proportion of heart failure with reduced ejection fraction (HFrEF) patients, echocardiographic estimation of left atrial pressure (LAP) is not possible when the ratio of the peak early left ventricular filling velocity over the late filling velocity (E/A ratio) is not available, which may occur due to several potential causes. Left atrial reservoir strain (LASr) is correlated with LV filling pressures and may serve as an alternative parameter in these patients. The aim of this study was to determine whether LASr can be used to estimate LAP in HFrEF patients in whom E/A ratio is not available. Methods and results Echocardiograms of chronic HFrEF patients were analysed and LASr was assessed with speckle tracking echocardiography. LAP was estimated using the current ASE/EACVI algorithm. Patients were divided into those in whom LAP could be estimated using this algorithm (LAPe) and into those in whom this was not possible because E/A ratio was not available (LAPne). We assessed the prognostic value of LASr on the primary endpoint (PEP), which comprised the composite of hospitalization for the management of acute or worsened HF, left ventricular assist device implantation, cardiac transplantation, and cardiovascular death, whichever occurred first in time. We studied 153 patients with a mean age of 58 years of whom 76% men and 82% who were in NYHA class I‐II. A total of 86 were in the LAPe group and 67 in the LAPne group. LASr was significantly lower in the LAPne group as compared with the LAPe group (15.8% vs. 23.8%, P < 0.001). PEP‐free survival at a median follow‐up of 2.5 years was 78% in LAPe versus 51% in LAPne patients. An increase in LASr was significantly associated with a reduced risk of the PEP in LAPne patients (adjusted hazard ratio: 0.91 per %, 95% confidence interval 0.84–0.98). An abnormal LASr (<18%) was associated with a five‐fold increase in reaching the PEP. Conclusions In HFrEF patients in whom echocardiographic estimation of LAP is not possible due to due to unavailability of E/A ratio, assessing LASr potentially carries added clinical and prognostic value.https://doi.org/10.1002/ehf2.14372Heart failure with reduced ejection fractionLeft atrial strainLeft atrial pressure |
| spellingShingle | Yaar S. Aga Sabrina Abou Kamar Jie Fen Chin Victor. J. van denBerg Mihai Strachinaru Daniel Bowen Rene Frowijn Martijn K. Akkerhuis Alina A. Constantinescu Victor Umans Marcel L. Geleijnse Eric Boersma Jasper J. Brugts Isabella Kardys Bas M. vanDalen Potential role of left atrial strain in estimation of left atrial pressure in patients with chronic heart failure ESC Heart Failure Heart failure with reduced ejection fraction Left atrial strain Left atrial pressure |
| title | Potential role of left atrial strain in estimation of left atrial pressure in patients with chronic heart failure |
| title_full | Potential role of left atrial strain in estimation of left atrial pressure in patients with chronic heart failure |
| title_fullStr | Potential role of left atrial strain in estimation of left atrial pressure in patients with chronic heart failure |
| title_full_unstemmed | Potential role of left atrial strain in estimation of left atrial pressure in patients with chronic heart failure |
| title_short | Potential role of left atrial strain in estimation of left atrial pressure in patients with chronic heart failure |
| title_sort | potential role of left atrial strain in estimation of left atrial pressure in patients with chronic heart failure |
| topic | Heart failure with reduced ejection fraction Left atrial strain Left atrial pressure |
| url | https://doi.org/10.1002/ehf2.14372 |
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