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. 2022 Aug 22;23(9):1157-1168.
doi: 10.1093/ehjci/jeac036.

Left atrial reservoir strain improves diagnostic accuracy of the 2016 ASE/EACVI diastolic algorithm in patients with preserved left ventricular ejection fraction: insights from the KARUM haemodynamic database

Ashwin Venkateshvaran  1 , Hande Oktay Tureli  2 , Ulrika Ljung Faxén  1   3 , Lars H Lund  1 , Erik Tossavainen  4 , Per Lindqvist  2
Affiliations

Left atrial reservoir strain improves diagnostic accuracy of the 2016 ASE/EACVI diastolic algorithm in patients with preserved left ventricular ejection fraction: insights from the KARUM haemodynamic database

Ashwin Venkateshvaran et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: This study aimed to investigate the incremental value offered by left atrial reservoir strain (LASr) to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) diastolic algorithm to identify elevated left ventricular (LV) filling pressure in patients with preserved ejection fraction (EF).

Methods and results: Near-simultaneous echocardiography and right heart catheterization were performed in 210 patients with EF ≥50% in a large, dual-centre study. Elevated filling pressure was defined as invasive pulmonary capillary wedge pressure (PCWP) ≥15 mmHg. LASr was evaluated using speckle-tracking echocardiography. Diagnostic performance of the ASE/EACVI diastolic algorithm was validated against invasive reference and compared with modified algorithms incorporating LASr. Modest correlation was observed between E/e', E/A ratio, and LA volume index with PCWP (r = 0.46, 0.46, and 0.36, respectively; P < 0.001 for all). Mitral e' and TR peak velocity showed no association. The ASE/EACVI algorithm (89% feasibility, 71% sensitivity, 68% specificity) demonstrated reasonable ability (AUC = 0.69) and 68% accuracy to identify elevated LV filling pressure. LASr displayed strong ability to identify elevated PCWP (AUC = 0.76). Substituting TR peak velocity for LASr in the algorithm (69% sensitivity, 84% specificity) resulted in 91% feasibility, 81% accuracy, and stronger agreement with invasive measurements. Employing LASr as per expert consensus (71% sensitivity, 70% specificity) and adding LASr to conventional parameters (67% sensitivity, 84% specificity) also demonstrated greater feasibility (98% and 90%, respectively) and overall accuracy (70% and 80%, respectively) to estimate elevated PCWP.

Conclusions: LASr improves feasibility and overall accuracy of the ASE/EACVI algorithm to discern elevated filling pressures in patients with preserved EF.

Keywords: diastolic dysfunction; echo Doppler; left ventricular filling pressure; right heart catheterization; speckle tracking echocardiography.

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Conflict of interest statement

Conflict of interest: A.V., H.O.T., and E.T. have no disclosures; U.L.F. received consulting honoraria from Orion Pharma and Anacardio; L.H.L. reports personal fees from Merck, grants and personal fees from Vifor-Fresenius, grants and personal fees from AstraZeneca, personal fees from Bayer, grants from Boston Scientific, personal fees from Pharmacosmos, personal fees from Abbott, personal fees from Medscape, personal fees from Myokardia, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, personal fees from Sanofi, personal fees from Lexicon, personal fees from Radcliffe cardiology, outside the submitted work; P.L. reports fees from Pfizer.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Apical four-chamber view illustrating speckle-tracking-enabled tracing and the corresponding strain curve.
Figure 2
Figure 2
Flow chart of patient selection.
Figure 3
Figure 3
Scatter plot demonstrating relationship between LASr and PCWP. The highlighted region corresponds with correctly classified LV filling pressure status by LASr (cut-off 18%).
Figure 4
Figure 4
(A) Receiver operating characteristic (ROC) analysis demonstrating diagnostic accuracy of LASr to identify PCWP ≥15 mmHg. (B) Receiver operating characteristic (ROC) analysis comparing diagnostic accuracy of ASE/EACVI algorithm (AUC = 0.69) with a modified algorithm that substitutes TR velocity for LASr to identify PCWP ≥15 mmHg (AUC = 0.77, P < 0.05 for comparison).
Figure 5
Figure 5
Models displaying the utility of left atrial (LA) reservoir strain to improve diagnostic ability of the 2016 ASE/EACVI recommendations to identify elevated left ventricular (LV) filling pressure.
See this image and copyright information in PMC

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