Echocardiographic Left Atrial Stiffness Index Predicts High Left Ventricular Filling Pressures in Patients with Acute Heart Failure: an Observational Study

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2024 Oct 28

PMID 39466444

Authors

Massimiliano Camilli

Ludovica Amore

Federico Ballacci

Giulia Iannaccone

Marco Giuseppe Del Buono

Federica Giordano

Francesca Graziani

Tommaso Sanna

Daniela Pedicino

Francesco Burzotta

Carlo Trani

Gaetano Antonio Lanza

Rocco Antonio Montone

Nadia Aspromonte

Laura Lupi

Marianna Adamo

Filippo Crea

Antonella Lombardo

Affiliations

Soon will be listed here.

Abstract

Background: In acute heart failure (AHF) patients, non-invasive estimation of left ventricular filling pressures (LVFPs) appears crucial to guide management. Although poorly investigated, left atrial (LA) mechanics play a pivotal role in this setting. This report sought to assess the correlation of echocardiographic LA stiffness index with invasive LVFPs and its diagnostic accuracy as compared to other parameters used in clinical practice.

Methods: In this observational, prospective study, 104 patients with suspected acute coronary syndrome and signs/symptoms of AHF were enrolled. Available invasive estimation of LVFPs was required. Comprehensive echocardiography was performed for all patients, including LA reservoir strain (LARS). LA stiffness index was derived by speckle-tracking analysis and Tissue Doppler imaging as early diastolic transmitral inflow velocity/mitral annulus early diastolic velocity [E/e']/LARS.

Results: Invasively measured LVFPs showed a strong correlation with LA stiffness index (Spearman ρ = 0.773, p < 0.0001), as well as with LARS and E/e'. Receiver operating characteristic (ROC) curve analysis was used to demonstrate better accuracy performed by LA stiffness index than average E/e', LA volume or LARS alone, in predicting high LVFPs. Guideline-recommended assessment of diastolic function was finally compared to LARS and LA stiffness index performances in an independent population group; we were hence able to obtain a LA stiffness threshold of 0.48 with a positive predictive value of 91.7% and a negative predictive value of 88.9% in identifying patients with high LVFPs.

Conclusions: For the first time, diagnostic performance of LA stiffness index has been investigated in a heterogeneous AHF population, providing correlations with invasively measured LVFPs and comparisons with established diastolic function metrics.

References

Nagueh S, Smiseth O, Appleton C, Byrd 3rd B, Dokainish H, Edvardsen T . Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29(4):277-314. DOI: 10.1016/j.echo.2016.01.011. View

Tomlinson S, Scalia G, Appadurai V, Edwards N, Savage M, Lam A . Left atrial reservoir strain provides incremental value to left atrial volume index for evaluation of left ventricular filling pressure. Echocardiography. 2021; 38(9):1503-1513. DOI: 10.1111/echo.15157. View

Iannaccone G, Graziani F, Del Buono M, Camilli M, Lillo R, Caffe A . Left atrial strain analysis improves left ventricular filling pressures non-invasive estimation in the acute phase of Takotsubo syndrome. Eur Heart J Cardiovasc Imaging. 2023; 24(6):699-707. PMC: 10274307. DOI: 10.1093/ehjci/jead045. View

Inoue K, Khan F, Remme E, Ohte N, Garcia-Izquierdo E, Chetrit M . Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure. Eur Heart J Cardiovasc Imaging. 2021; 23(1):61-70. PMC: 8685600. DOI: 10.1093/ehjci/jeaa415. View

Thomas L, Abhayaratna W . Left Atrial Reverse Remodeling: Mechanisms, Evaluation, and Clinical Significance. JACC Cardiovasc Imaging. 2017; 10(1):65-77. DOI: 10.1016/j.jcmg.2016.11.003. View

Thomas L, Marwick T, Popescu B, Donal E, Badano L . Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019; 73(15):1961-1977. DOI: 10.1016/j.jacc.2019.01.059. View

Bytyci I, Bajraktari G, Fabiani I, Lindqvist P, Poniku A, Pugliese N . Left atrial compliance index predicts exercise capacity in patients with heart failure and preserved ejection fraction irrespective of right ventricular dysfunction. Echocardiography. 2019; 36(6):1045-1053. DOI: 10.1111/echo.14377. View

Camilli M, Iannaccone G, Russo M, Meucci M, Chiorazzo G, Natali R . Early improvement of strain imaging parameters predicts long-term response to sacubitril/valsartan in patients with heart failure with reduced ejection fraction: An observational prospective study. Int J Cardiol. 2023; 387:131110. DOI: 10.1016/j.ijcard.2023.06.001. View

Kim D, Seo J, Choi K, Lee S, Choi J, Jeon E . Prognostic Implications of Left Atrial Stiffness Index in Heart Failure Patients With Preserved Ejection Fraction. JACC Cardiovasc Imaging. 2023; 16(4):435-445. DOI: 10.1016/j.jcmg.2022.11.002. View

10.

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3):233-70. DOI: 10.1093/ehjci/jev014. View

11.

Rudski L, Lai W, Afilalo J, Hua L, Handschumacher M, Chandrasekaran K . Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology,.... J Am Soc Echocardiogr. 2010; 23(7):685-713. DOI: 10.1016/j.echo.2010.05.010. View

12.

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1):1-39.e14. DOI: 10.1016/j.echo.2014.10.003. View

13.

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J . 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2021; 43(7):561-632. DOI: 10.1093/eurheartj/ehab395. View

14.

Del Buono M, Montone R, Meucci M, La Vecchia G, Camilli M, Giraldi L . Left ventricular end-diastolic pressure predicts in-hospital outcomes in takotsubo syndrome. Eur Heart J Acute Cardiovasc Care. 2021; 10(6):661-667. DOI: 10.1093/ehjacc/zuab028. View

15.

Santos M, Rivero J, McCullough S, West E, Opotowsky A, Waxman A . E/e' Ratio in Patients With Unexplained Dyspnea: Lack of Accuracy in Estimating Left Ventricular Filling Pressure. Circ Heart Fail. 2015; 8(4):749-56. PMC: 4512932. DOI: 10.1161/CIRCHEARTFAILURE.115.002161. View

16.

Lancellotti P, Galderisi M, Edvardsen T, Donal E, Goliasch G, Cardim N . Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study. Eur Heart J Cardiovasc Imaging. 2017; 18(9):961-968. DOI: 10.1093/ehjci/jex067. View

17.

Obokata M, Borlaug B . The strengths and limitations of E/e' in heart failure with preserved ejection fraction. Eur J Heart Fail. 2018; 20(9):1312-1314. PMC: 6125220. DOI: 10.1002/ejhf.1250. View

18.

Nauta J, Hummel Y, van der Meer P, Lam C, Voors A, van Melle J . Correlation with invasive left ventricular filling pressures and prognostic relevance of the echocardiographic diastolic parameters used in the 2016 ESC heart failure guidelines and in the 2016 ASE/EACVI recommendations: a systematic review in.... Eur J Heart Fail. 2018; 20(9):1303-1311. DOI: 10.1002/ejhf.1220. View

19.

Douglas P . The left atrium: a biomarker of chronic diastolic dysfunction and cardiovascular disease risk. J Am Coll Cardiol. 2003; 42(7):1206-7. DOI: 10.1016/s0735-1097(03)00956-2. View

20.

Tsang T, Abhayaratna W, Barnes M, Miyasaka Y, Gersh B, Bailey K . Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?. J Am Coll Cardiol. 2006; 47(5):1018-23. DOI: 10.1016/j.jacc.2005.08.077. View