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The Left atrial strain provide improved diagnostics for elevated filling pressures at rest and/or during exercise in heart failure patients

Session Comorbidities and cardiomyopathies - How to manage?

Speaker Associate Professor Aristomenis Manouras

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Hemodynamics of Heart Failure
  • Session type : Rapid Fire Abstracts

Authors : A Manouras (Stockholm,SE), A Lundberg (Stockholm,SE), M Back (Stockholm,SE), LA Lund (Stockholm,SE), A Nagy (Budapest,HU)

Authors:
A Manouras1 , A Lundberg1 , M Back1 , LA Lund1 , A Nagy2 , 1Karolinska Institute, Institute of Medicine Solna - Stockholm - Sweden , 2Semmelweis University, Heart and Vascular Center - Budapest - Hungary ,

Citation:

Background/Introduction - The non-invasive assessment of left ventricular diastolic function and filling pressures is an important clinical question. Particularly challenging is the diagnosis of those patients whose left atrial pressure (LAP) is within normal range at rest, but increases pathologically on exertion. Current recommendations on diastolic assessment are complex, have limited diagnostic accuracy and provide no guidance for that latter scenario.

Purpose -As recent data suggests that the LA constitutes an important pathophysiological substrate of diastolic heart failure we hypothesized that mechanical alteration in LA function, as expressed by reduced LA strain (LA-GS), might contribute in identification of elevated LAP and thus sought to investigate this question.

Methods – 220 patients referred for right heart catheterization (RHC) to Karolinska University Hospital for HF assessment were enrolled prospectively. Simultaneous echocardiographic examination and RHC at rest and during exercise was performed. Patients with precapillary pulmonary hypertension, constrictive pericarditis and significant valvular disease were excluded

Results – In total 164 patients were included. 56% of the patients had preserved EF. At rest, the pulmonary arterial wedge pressure (PAWP) was elevated in 97 patients and further 34 patients with normal resting PAWP values demonstrated abnormal PAWP elevation during exercise. LA-GS measurements was feasible in 97% of the patients. LA-GS showed the strongest correlation with resting PAWP (r=- 0.64 for preserved EF, and -0.46 for reduced EF, p<0.001 in both cases) compared to the individual indices (E/E´, LAVi, TR-Vmax) incorporated in the currently recommended diagnostic EACVI algorithm. The diagnostic performance of LA-GS for detecting elevated resting PAWP was good (AUC:0.87 and 0.74 in patients with preserved and HFrEF, respectively). More importantly, resting LA-GS values performed even better for identifying patients with pathological PAWP either at rest or on stress (AUC:0.90 and 0.80, respectively). On the other hand, the currently proposed EACVI algorithm demonstrated a modest diagnostic ability limited in patients with preserved EF (AUC=0.69 at rest and 0.67 for detecting patients with pathological PAWP either at rest or on exertion). Conclusion(s) – Resting LA-GS provides superior diagnostic discrimination between normal and elevated PAWP values at rest as compared to EACVI algorithm. More importantly, resting LA-GS demonstrates augmented diagnostic ability for patients with pathological elevation of PAWP during exertion.

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