Correlation between Left Atrial Echocardiographic Deformation Parameters and Invasive Left Ventricular End-Diastolic Pressure Measurements

Maryam  Noroozi; Ehsan  Khalilipur; Mohammadreza  Baay; Hamideh  Khesali; Hooman  Bakhshandeh; Saeed  Cheraghi; Ebrahim  Salehi; Reza  Salmannejad; Elahe  Emami; Melody  Farrashi

doi:10.18502/jthc.v19is1.18476

Maryam Noroozi Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran.
Ehsan Khalilipur Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran.
Mohammadreza Baay Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran.
Hamideh Khesali Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran.
Hooman Bakhshandeh Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
Saeed Cheraghi Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran.
Ebrahim Salehi Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
Reza Salmannejad Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran.
Elahe Emami Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran.
Melody Farrashi Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran.

DOI: https://doi.org/10.18502/jthc.v19is1.18476

Keywords: Left atrium; Longitudinal strain; Left ventricular end‐diastolic pressure; Echocardiography; Cardiac catheterization; Speckle tracking; Diastolic dysfunction

Abstract

Background: The noninvasive estimation of elevated left ventricular end-diastolic pressure (LVEDP) is a critical step in assessing left ventricular diastolic dysfunction (LVDD). Nonetheless, most echocardiographic parameters currently used for this purpose have significant limitations. Recent studies have highlighted the utility of left atrial (LA) strain as a noninvasive method for estimating LVEDP. This study aimed to explore the correlations between LA deformation parameters, measured using speckle-tracking echocardiography (STE), and invasively obtained LVEDP.

Methods: This prospective study involved 82 patients in sinus rhythm who underwent left heart catheterization at our center. All participants underwent comprehensive transthoracic echocardiography and peak atrial longitudinal strain (PALS) assessment via STE within 12 hours before catheterization.

Results: LVEDP was elevated in 45 patients (54.9%) and normal in 37 (45.1%). PALS, LA ejection fraction, and septal E’ showed moderate inverse correlations with LVEDP (r= −0.590, P=0.001; r= −0.463, P=0.001; and r= −0.449, P=0.001, respectively). The E/E’ ratio also exhibited a moderate correlation with LVEDP (r=0.567, P=0.001). Lateral E’ and the E/A ratio demonstrated weaker inverse correlations with LVEDP (r= −0.231, P=0.037 and r= −0.229, P=0.038, respectively). In multivariate logistic regression analysis, age (OR, 1.14, 95% CI, 1.02 to 1.27), PALS (OR, 0.77, 95% CI, 0.65 to 0.91), and the E/E’ ratio (OR, 1.36, 95% CI, 1.11 to 1.89) were identified as independent predictors of an LVEDP≥12 mm Hg. PALS demonstrated the highest diagnostic accuracy for predicting an LVEDP≥12 mm Hg, with an AUC of 0.849 (95% CI, 0.764 to 0.935; P<0.001). A PALS cutoff value of 35% yielded a sensitivity of 81.1% and a specificity of 81.4% for predicting elevated LVEDP.

Conclusion: PALS emerged as a reliable noninvasive parameter for predicting elevated LVEDP. Its application may facilitate the earlier identification of LVDD.