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Understanding the geometric basis for longitudinal left atrial strain and its relation to left ventricular measures

Session Poster session 2

Speaker Dhnanjay Soundappan

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Deformation Imaging
  • Session type : Poster Session

Authors : D Soundappan (Sydney,AU), F Frojdh (Stockholm,SE), D Loewenstein (Stockholm,SE), P Sorensson (Stockholm,SE), A Sigfridsson (Stockholm,SE), E Maret (Stockholm,SE), E Schelbert (Pittsburgh,US), R Kozor (Sydney,AU), M Ugander (Stockholm,SE)

Authors:
D Soundappan1 , F Frojdh2 , D Loewenstein2 , P Sorensson2 , A Sigfridsson2 , E Maret2 , E Schelbert3 , R Kozor1 , M Ugander2 , 1University of Sydney, Department of Cardiology - Sydney - Australia , 2Karolinska Institute, Department of Clinical Physiology - Stockholm - Sweden , 3University of Pittsburgh, Medicine - Pittsburgh - United States of America ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii353

Background: Longitudinal left atrial (LA) strain has emerged as an attractive indicator of increased left ventricular (LV) filling pressures and poor prognosis. However, it is unclear how LA strain relates to other conventional geometric measures of the LA and LV, and to what extent each of these contribute to LA strain.

Purpose: To better understand the geometric basis of LA strain measurement by addressing the hypothesis that LA strain is associated with many conventional geometric measures of LA and LV volume and function.

Methods: Patients (n=48) referred clinically for cardiovascular magnetic resonance (CMR) (1.5T or 3T MAGNETOM Aera or Skyra, Siemens Healthcare, Erlangen, Germany) were retrospectively included based on a desired even distribution of LV ejection fraction (range 12-72%) and the absence of functionally distinct myocardial disease (e.g. amyloidosis, hypertrophic cardiomyopathy). Cine images were used for all measures using commercially available software (Segment, Medviso, Lund, Sweden). LA area and length at both ventricular end diastole and end systole, were measured in the two chamber long-axis view. LV end-diastolic volume, LV stroke volume, LV ejection fraction, LV mass, LV global longitudinal strain (GLS), mitral annular plane systolic excursion (MAPSE), and LV length in end diastole were measured using established clinical methods. Body surface area was estimated based on height and weight. Associations were evaluated using univariate and multivariate linear regression.

Results: LA strain was associated by univariate analysis with all evaluated measures (R2=0.08-0.60, p<0.05 for all) with the exception of LV stroke volume and body surface area. In multivariable analysis, only MAPSE, LV length and LA end-diastolic area were significant contributors to explaining LA strain (global adjusted R2=0.76, p<0.001, see Table).

Conclusion: LA strain is a composite measure that is closely related to both LV and LA geometry and function. It is possible to derive an excellently accurate estimate of LA strain, using only simple measures of the LV and LA commonly accessible in CMR post processing analysis.

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