Abstract 2921: Left Atrial Dimension Corrected by Left Ventricular Diastolic Myocardial Radial Strain is Useful in Assessing Left Ventricular End-diastolic Pressure
Background: In assessing left ventricular (LV) end-diastolic pressure (EDP) noninvasively, not only left atrial (LA) function but also LV compliance should be considered. Recently developed tissue strain imaging (TSI) enables us to evaluate myocardial extensibility during diastole. Accordingly, we investigated whether LVEDP could be predicted using a new parameter, ie, LA dimension at LV end-systole (LADs) corrected by LV diastolic myocardial strain (%thinning from end systole).
Methods: Study subjects consisted of 112 patients collected from our data base of 322 patients underwent TSI and diagnostic cardiac catheterization on the same day. In all patients, leftventriculography and LVEDP measurement were performed. Fifty-six had prior myocardial infarction (MI). Thirty-nine were anterior MI, 11 inferior and 6 were anterior plus inferior wall MI. Fourteen of those had a LV apical aneurysm. The remaining 56 had no localized LV wall motion abnormality. Peak radial strain during early diastole (PS-ED) and that at end-diastole (PS-END) were obtained at the opposite wall of infarct region in patients with prior MI on the LV short-axis image. In the patients without localized wall motion abnormality, PS-ED and PS-END were obtained at the posterior wall. LADs (a distance from the atrial septum to the lateral wall of LA) was obtained in each patient on the apical 4 chamber image. Our new index for estimating LVEDP (cLADs) was defined as follow: cLADs = LADs × PS-END/PS-ED.
Results: In all patients, weak but significant correlations were observed between LADs and LVEDP (r = 0.42, p < 0.0001) and between cLADs and LVEDP (r = 0.51, p < 0.0001). In contrast, if the patients who had an apical aneurysm are excluded, a significant and much closer correlation was observed between cLADs and LVEDP (r = 0.72, p < 0.0001).
Conclusions: These findings indicate that LADs corrected by the ratio of LV extensibility during early diastole and that of atrial contraction is a new useful parameter for noninvasive prediction of LVEDP.