Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure

Cardiovascular Ultrasound

Research

Piercarlo Ballo¹  Sonia Bernazzali²  Charilaos Tsioulpas²  Massimo Maccherini²  Sergio Mondillo³  Matteo Lisi³  Margherita Padeletti³  Matteo Cameli³ 

[1] Cardiology Operative Unit, S. Maria Annunziata Hospital, Firenze, Italy;Department of Cardiothoracic Surgery, University of Siena, Italy;Department of Cardiovascular Diseases, University of Siena, Siena, Italy;

关键词: Left Atrial;    Pulmonary Capillary Wedge Pressure;    Filling Pressure;    Tissue Doppler Imaging;    Left Atrial Volume;   

DOI  :  10.1186/1476-7120-8-14

 received in 2010-03-17, accepted in 2010-04-21,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundThe combination of early transmitral inflow velocity and mitral annular tissue Doppler imaging (E/Em ratio) is widely applied to noninvasively estimate left ventricular (LV) filling pressures. However E/Em ratio has a significant gray zone and its accuracy in patients with heart failure is debated. Left atrial (LA) deformation analysis by speckle tracking echocardiography (STE) was recently proposed as an alternative approach to estimate LV filling pressures. This study aimed at exploring the correlation of LA longitudinal function by STE and Doppler measurements with direct measurements of LV filling pressures in patients with heart failure.MethodsA total of 36 patients with advanced systolic heart failure (ejection fraction ≤35%), undergoing right heart catheterization, were studied. Simultaneously to pulmonary capillary wedge pressure (PCWP) determination, peak atrial longitudinal strain (PALS) and mean E/Em ratio were measured in all subjects by two independent operators. PALS values were obtained by averaging all segments (global PALS), and by separately averaging segments measured in the 4-chamber and 2-chamber views.ResultsNot significant correlation was found between mean E/Em ratio and PCWP (R = 0.15). A close negative correlation between global PALS and the PCWP was found (R = -0.81, p < 0.0001). Furthermore, global PALS demonstrated the highest diagnostic accuracy (AUC of 0.93) and excellent sensitivity and specificity of 100% and 93%, respectively, to predict elevated filling pressure using a cutoff value less than 15.1%. Bland-Altman analysis confirmed this close agreement between PCWP estimated by global PALS and invasive PCWP (mean bias 0.1 ± 8.0 mmHg).ConclusionIn a group of patients with advanced systolic heart failure, E/Em ratio correlated poorly with invasively obtained LV filling pressures. However, LA longitudinal deformation analysis by STE correlated well with PCWP, providing a better estimation of LV filling pressures in this particular clinical setting.

【 授权许可】

CC BY   
© Cameli et al; licensee BioMed Central Ltd. 2010