Non-invasive markers for the improvement of cardiac diagnostics

Demonstration of elevated left ventricular (LV) filling pressure is important for the heart failure (HF) diagnosis. In a joint recommendation from the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI), it was proposed to use a combination of several echocardiographic parameters to evaluate left ventricular filling pressure.

Left atrial (LA) reservoir and pump strain measured by speckle tracking echocardiography are proposed as supplementary markers of left ventricular filling pressure.

The proposed protocol including standardization of how to measure strain, and other echocardiographic and haemodynamic parameters was agreed on by all the participating centres. All statistical analyses were performed at the core laboratory at Oslo University Hospital.

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For application in clinical diagnostics, it is important to understand which factors other than LV filling pressure determine the magnitude of the LA strain components. Therefore, the present multicentre study investigates determinants of LA reservoir and pump strain by studying patients with a wide range of cardiac disorders. Furthermore, the study investigates how LA strain may be used in combination with other echocardiographic parameters in the evaluation of LV filling pressure. The study is done with echocardiographic equipment from different vendors, and invasive pressure is used as gold standard for LV filling pressure.

In patients with reduced LV systolic function, LA reservoir and pump strain predicted LV filling pressure better than conventional echocardiographic markers. High normal values of LA pump strain identified normal filling pressure with high accuracy. When used in combination with the conventional markers, LA strain increases the feasibility of using echo Doppler parameters to estimate LV filling pressure as it provides an additional variable to consider when one of the others is missing.

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

Eur Heart J Cardiovasc Imaging. 2021 Jan 26;jeaa415

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