Abstract 18520: Can Left Atrial Wall Area Strain Obtained by Three-dimensional Speckle Tracking Imaging Assess Left Ventricular Filling Pressure in Patients with Normal Left Ventricular Ejection Fraction?
Left atrial (LA) reservoir and booster pump function plays substantially important roles in optimizing left ventricular (LV) filling pressure. Our hypothesis was that elevated LV filling pressure deteriorates LA deformation in patients with impaired LV relaxation, even if the LV ejection fraction (EF) is preserved. We investigated this issue by assessing LA wall area strain (AS) using the 3-dimensional speckle tracking imaging (3D-STI).
Methods: Study subjects were 82 patients with sinus rhythm who underwent diagnostic cardiac catheterization and 3D-STI (ArtidaTM, Toshiba) on the same day. Twenty-seven of them were prior myocardial infarction, 7 were dilated cardiomyopathy, while remaining 48 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 as the parameters of LA function. Early mitral annular velocities (e’) at the both septal and lateral corners of the mitral annulus were obtained using tissue Doppler imaging. The patients with lateral e’<8.5cm/sec or septal e’<8 cm/sec were defined as the subset of impaired LV relaxation. LVEF was calculated using the biplane modified Simpson’s method. LV pressure was obtained using a catheter-tipped micromanometer; then mean LV diastolic pressure (m-LVDP) was computed.
Results: In all patients, the peak AS and the AS-preA significantly correlated with the m-LVDP (r=-0.70, p<0.001 and r=-0.69, p<0.001, respectively). In patients with impaired LV relaxation (n=64), the peak AS and the AS-preA significantly correlated with the m-LVDP (r=-0.73, p<0.001 and r=-0.76, p<0.001, respectively). Furthermore, in patients with impaired LV relaxation and preserved LVEF (>50%, n=53), the peak AS and the AS-preA also significantly correlated with the m-LVDP (r=-0.67, p<0.001 and r=-0.78, p<0.001, respectively).
Conclusions: This study indicates that an elevated LA pressure could deteriorate both LA reservoir and booster pump function. LA-AS obtained by 3D-STI is an emerging parameter for the noninvasive prediction of m-LVDP, even in patients with preserved LVEF.
Author Disclosures: N. Ikehara: None. K. Wakami: None. T. Goto: None. T. Sugiura: None. H. Fukuta: None. T. Tani: None. N. Ohte: None.
- © 2014 by American Heart Association, Inc.