Key result
LA reservoir strain <18% outperforms traditional echo parameters in detecting increased LV filling pressure.
Why the study?
LA reservoir strain <18% and booster strain <8% detect increased LV filling pressure in acquired heart disease, but whether these cut-off points detect increased LV filling pressure in adults with coarctation of aorta was unknown.
Does left atrial strain accurately detect increased left ventricular filling pressure in adults with coarctation of aorta compared to traditional echocardiographic parameters?
Observational (n=126)
Does left atrial strain accurately detect increased left ventricular filling pressure in adults with coarctation of aorta compared to traditional echocardiographic parameters?
Left atrial reservoir strain <18% is superior to traditional echocardiographic parameters for detecting increased left ventricular filling pressure in adults with coarctation of the aorta.
May support noninvasive filling pressure assessment in coarctation; leaves open need for validation before practice change.
BACKGROUND: Left atrial (LA) reservoir strain <18% and booster strain <8% have been proposed as the optimal threshold to detect increased left ventricular (LV) filling pressure in patients with acquired heart disease. The purpose of this study was to determine whether these LA strain cut-off points can detect increased LV filling pressure in adults with coarctation of aorta (COA). METHODS: This retrospective study included adults with COA (n = 126; age, 36 ± 16 years) who underwent non-simultaneous cardiac catheterization and echocardiography. Increased LV filling pressure was defined as pulmonary artery wedge pressure (PAWP) >12 mm Hg or LV end-diastolic pressure (LVEDP) >16 mm Hg. RESULTS: The median PAWP was 13 mm Hg (interquartile range [IQR], 11-18) and PAWP had a good correlation with LA reservoir strain (r = -0.69; P<.001) and LA booster strain (r = -0.61; P<.001). LA reservoir strain <18% had superior diagnostic power to detect PAWP >12 mm Hg as compared with LA volume index >34 mL/m², septal E/e' >15, lateral E/e' >13, and tricuspid regurgitation velocity >2.8 m/s (P<.05 for all). The median LVEDP was 17 mm Hg (IQR, 14-20) and LVEDP had a modest correlation with LA reservoir strain (r = -0.39; P<.001) and LA booster strain (r = -0.33; P<.01). LA reservoir strain <18% had superior diagnostic power to detect LVEDP >16 mm Hg as compared with LA volume index >34 mL/m², septal E/e' >15, lateral E/e' >13, and tricuspid regurgitation velocity >2.8 m/s (P<.05 for all). CONCLUSIONS: These data suggest that LA strain could potentially be used to identify patients with increased LV filling pressure, thereby improving patient selection for cardiac catheterization and interventions.
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Egbe et al. (2022) conducted an observational in Coarctation of aorta (n=126). Left atrial reservoir strain <18% vs. LA volume index >34 mL/m², septal E/e' >15, lateral E/e' >13, and tricuspid regurgitation velocity >2.8 m/s was evaluated on Detection of increased LV filling pressure (PAWP >12 mm Hg or LVEDP >16 mm Hg) (p=<.05). Left atrial reservoir strain <18% had superior diagnostic power to detect increased left ventricular filling pressure compared to other echocardiographic parameters (P<.05 for all).
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