Left atrial reservoir strain as a predictor for left ventricular filling pressure in patients with sinus rhythm

Figures

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  Fig. 1. AUC of LASr to predict elevated LV filling pressure of LVEDP ≥ 16 mmHg and LV pre-A pressure ≥ 15 mmHg. LV pre-A ≥ 15 mmHg had a higher AUC than LVEDP ≥ 16 mmHg with an LASr cutoff of 24% (p = 0.021). LVEDP, left ventricular end-diastolic pressure; pre-A, pre-atrial contraction.

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  Fig. 2. AUC of sequantial models to predict elevated LV filling pressure of (A) LVEDP ≥ 16 mmHg and (B) LV pre-A pressure ≥ 15 mmHg. LASr demonstrated incremental value in sequential models for predicting LV pre-A pressure ≥ 15 mmHg, but not for LVEDP ≥ 16 mmHg. Model A includes the biomarker NT-proBNP, and Model B expands on Model A by incorporating various echocardiographic parameters from the HFA-PEFF diagnostic algorithm (septal e’, average E/e’, LV-GLS, peak velocity of tricuspid regurgitation, LA volume index, relative wall thickness, LV mass index). Model C expands on Model B by incorporating LASr as continuous variable. LASr, left atrial reservoir strain.

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  Fig. 3. Application of LASr to current diastolic function guideline. (A) Among 26 (13.5% of patients with normal ejection fraction) patients classified as ‘indeterminate’ based on the 2016 diastolic function guideline, Nineteen with LASr > 24% were reclassified as ‘normal’, of whom 18 (94.7%) had normal LV filling pressure. (B) Among 8 patients classified as ‘inconclusive’ (LASr 31.4 ± 7.3%), none had an LASr < 24%, and all had normal LV filling pressure.

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  Fig. 4. Representative example to measure LAS. The width of the region of interest was set to 3 mm in accordance with guideline recommendation. LAS indicates left atrial strain.