Abstract 15173: Left Atrial Wall Deformation Assessed by 3-Dimensional Speckle Tracking Imaging is a Useful Method in Assessing Left Ventricular Filling Pressure
In the subset with the ratio of early mitral inflow velocity (E) to early mitral annulus velocity (e’), that is the E/e’ ratio, ranged from 8 to 15, the E/e’ has been considered not to be able to precisely assess left ventricular (LV) filling pressure. Several previous studies have reported that elevated left atrial (LA) pressure deteriorates LA wall distensibility. Three-dimensional speckle tracking imaging (3D-STI) technique enables us to assess LA wall area strain (AS). Accordingly, we investigated whether the elevated LV filling pressure could be predicted by measuring the LA-AS.
Methods: Study subjects were 69 patients with sinus rhythm who underwent diagnostic cardiac catheterization and 3D-STI (ArtidaTM, Toshiba) on the same day. Twenty-two of them had prior myocardial infarction, while the remaining 47 had no localized LV wall motion abnormality. The temporal changes of global LA-AS were drawn offline using an echo image analyzer (Ultra-ExtendTM, Toshiba). Both the peak LA-AS value at LV end-systole (peak AS) and the LA-AS value just before LA contraction (AS-preA) were measured. The averaged e’ at the both septal and lateral corners of the mitral annulus was obtained using tissue Doppler imaging, and then the averaged E/e’ was calculated. LV ejection fraction (EF) was calculated using the biplane modified Simpson’s method. LV pressure wave was obtained using a catheter-tipped micromanometer, and then mean LV diastolic pressure (m-LVDP) was computed.
Results: In all patients, the peak AS and the AS-preA had significant correlations with the m-LVDP (r=-0.72, p<0.001 and r=-0.69, p<0.001, respectively). In patients with preserved LVEF (more than 50%, n=60), the peak AS and the AS-preA also significantly correlated with the m-LVDP (r=-0.67, p<0.001 and r=-0.68, p<0.001, respectively). Furthermore, in patients with preserved LVEF and the averaged E/e’ from 8 to 13 (n=33), the peak AS and the AS-preA also significantly correlated with the m-LVDP (r=-0.50, p<0.01 and r=-0.80, p<0.001, respectively).
Conclusions: This study indicates that elevated LA pressure could deteriorate both LA reservoir and booster pump function. LA-AS obtained by 3D-STI is a novel useful parameter for the noninvasive prediction of m-LVDP, even in patients with preserved LVEF.
Author Disclosures: K. Wakami: None. S. Kikuchi: None. S. Kikuchi: None. N. Ikehara: None. T. Goto: None. T. Sugiura: None. H. Fukuta: None. T. Tani: None. N. Ohte: None.
- © 2014 by American Heart Association, Inc.