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Multicenter Study
. 2021 Dec 18;23(1):61-70.
doi: 10.1093/ehjci/jeaa415.

Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure

Katsuji Inoue  1   2 , Faraz H Khan  1 , Espen W Remme  1 , Nobuyuki Ohte  3 , Eusebio García-Izquierdo  4 , Michael Chetrit  5 , Vanessa Moñivas-Palomero  4 , Susana Mingo-Santos  4 , Øyvind S Andersen  1 , Einar Gude  1 , Arne K Andreassen  1 , Tom Kai Ming Wang  6 , Shohei Kikuchi  3 , Marie Stugaard  7 , Jong-Won Ha  8 , Allan L Klein  6 , Sherif F Nagueh  9 , Otto A Smiseth  1
Affiliations
Multicenter Study

Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure

Katsuji Inoue et al. Eur Heart J Cardiovasc Imaging. .

Erratum in

Abstract

Aims: The aim of this study is to investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as non-invasive markers of left ventricular (LV) filling pressure.

Methods and results: In a multicentre study of 322 patients with cardiovascular disease of different aetiologies, LA strain and other echocardiographic parameters were compared with invasively measured LV filling pressure. The strongest determinants of LA reservoir and pump strain were LV global longitudinal strain (GLS) (r-values 0.64 and 0.51, respectively) and LV filling pressure (r-values -0.52 and -0.57, respectively). Left atrial volume was another independent, but weaker determinant of both LA strains. For both LA strains, association with LV filling pressure was strongest in patients with reduced LV ejection fraction. Left atrial reservoir strain <18% and LA pump strain <8% predicted elevated LV filling pressure better (P < 0.05) than LA volume and conventional Doppler parameters. Accuracy to identify elevated LV filling pressure was 75% for LA reservoir strain alone and 72% for pump strain alone. When combined with conventional parameters, accuracy was 82% for both LA strains. In patients with normal LV systolic function by GLS, LA pump strain >14% identified normal LV filling pressure with 92% accuracy.

Conclusion: Left atrial reservoir and pump strain are determined predominantly by LV GLS and filling pressure. Accuracy of LA strains to identify elevated LV filling pressure was best in patients with reduced LV systolic function. High values of LA pump strain, however, identified normal LV filling pressure with good accuracy in patients with normal systolic function.

Keywords: catheterization; diastolic dysfunction; heart failure; left atrial strain; left ventricular filling pressure.

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Figures

None
Determinants and clinical application of LA reservoir and pump strain: Panel A: Apical 4-chamber image with colour coded region of interest for LA strain and the LA strain trace. Panel B: Relationship between LA reservoir strain and LV filling pressure in the total population. Panel C: Left atrial pump strain > 14% identifies normal LV filling pressure. Panel D: ROC curves for classification of LV filling pressure as normal or elevated. For comparison, curves are from the 235 patients where pump strain could be assessed. Panel E: Illustrates how LA strain may be incorporated in the decision algorithm for evaluation of LV filling pressure from the 2016 ASE/EACVI guideline (2).
Figure 1
Figure 1
Determinants of LA strain. Relation between LA reservoir strain and its determinants (upper panels) and LA pump strain and its determinants (lower panels). GLS, global longitudinal strain; LA, left atrial; LV, left ventricular.
Figure 2
Figure 2
Relations between conventional echocardiographic markers and LV filling pressure. LA, left atrial; LV, left ventricular; TR, tricuspid regurgitation.
Figure 3
Figure 3
Classification of LV filling pressure by LA reservoir and pump strain. ROC curves showing ability of LA reservoir strain (n = 309) (A) and LA pump strain (n = 235) (B) to classify LV filling pressure as normal or elevated. Each panel includes two ROC curves according to different definitions of LV filling pressure as normal or elevated, using cut-offs of >12 and ≥15 mmHg. Systolic function is classified using LV EF (left) and LV GLS (right). Classification was best in patients with reduced systolic function as reflected in larger AUC in ROC curves. There was no significant difference in classifying LV filling pressure between the two cut-off values. AUC, area under the curve; GLS, global longitudinal strain; LA, left atrial; LV, left ventricular; ROC, receiver operating characteristic.
Figure 4
Figure 4
Diagnostic value of a high LA reservoir and pump strain. When LA reservoir strain exceeds 24% or pump strain exceeds 14%, few patients have elevated LV filling pressure. LA, left atrial; LV, left ventricular.
Figure 5
Figure 5
Correlations between LA strains and LV GLS to LV filling pressure among different vendors. GLS, global longitudinal strain; LA, left atrial; LV, left ventricular.
See this image and copyright information in PMC

Comment in

References

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