Evaluating left atrial strain and left ventricular diastolic strain rate as markers for diastolic dysfunction in patients with mitral annular calcification

Author:

Chen Edward W.,Bashir Zubair,Churchill Jessica L.,Has Phinnara,Klas Berthold,Aurigemma Gerard P.,Bisaillon Jonathan,Dickey John B.,Haines Philip

Abstract

Abstract Background Mitral annular calcification (MAC) poses many challenges to the evaluation of diastolic function using standard echocardiography. Left atrial (LA) strain and left ventricular early diastolic strain rate (DSr) measured by speckle-tracking echocardiography (STE) are emerging techniques in the noninvasive evaluation of diastolic function. We aim to evaluate the utility of LA strain and early DSr in predicting elevated left ventricular filling pressures (LVFP) in patients with MAC and compare their effectiveness to ratio of mitral inflow velocity in early and late diastole (E/A). Methods We included adult patients with MAC who presented between January 1 and December 31, 2014 and received a transthoracic echocardiogram (TTE) and cardiac catheterization with measurement of LVFP within a 24-h period. We used Spearman’s rank correlation coefficient to assess associations of LA reservoir strain and average early DSr with LVFP. Receiver operating characteristic (ROC) curves were computed to assess the effectiveness of LA strain and DSr in discriminating elevated LVFP as a dichotomized variable and to compare their effectiveness with E/A ratio categorized according to grade of diastolic dysfunction. Results Fifty-five patients were included. LA reservoir strain demonstrated poor correlation with LVFP (Spearman’s rho = 0.03, p = 0.81) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.54, 95% CI 0.38–0.69). Categorical E/A ratio alone also demonstrated poor discriminatory ability (AUC = 0.53, 95% CI 0.39–0.67), and addition of LA reservoir strain did not significantly improve effectiveness (AUC = 0.58, 95% CI 0.42–0.74, p = 0.56). Average early DSr also demonstrated poor correlation with LVFP (Spearman’s rho = −0.19, p = 0.16) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.59, 95% CI 0.44–0.75). Addition of average early DSr to categorical E/A ratio failed to improve effectiveness (AUC = 0.62, 95% CI 0.46–0.77 vs. AUC = 0.54, 95% CI 0.39–0.69, p = 0.38). Conclusions In our sample, LA reservoir strain and DSr do not accurately predict diastolic filling pressure. Further research is required before LA strain and early DSr can be routinely used in clinical practice to assess filling pressure in patients with MAC.

Publisher

Springer Science and Business Media LLC

Reference45 articles.

1. Diwan A, McCulloch M, Lawrie GM, Reardon MJ, Nagueh SF (2005) Doppler estimation of left ventricular filling pressures in patients with mitral valve disease. Circulation 111:3281–3289. https://doi.org/10.1161/CIRCULATIONAHA.104.508812

2. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF III, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29:277–314. https://doi.org/10.1016/j.echo.2016.01.011

3. Ariza J, Casanova MA, Esteban F, Ciudad MM, Trapiello L, Herrera N (2016) Peak early diastolic mitral annulus velocity by tissue Doppler imaging for the assessment of left ventricular relaxation in subjects with mitral annulus calcification. Eur Heart J Cardiovasc Imaging 17:804–811. https://doi.org/10.1093/ehjci/jev219

4. Codolosa JN, Koshkelashvili N, Alnabelsi T, Goykhman I, Romero-Corral A, Pressman GS (2016) Effect of mitral annular calcium on left ventricular diastolic parameters. Am J Cardiol 117:847–852. https://doi.org/10.1016/j.amjcard.2015.12.010

5. Soeki T, Fukuda N, Shinohara H, Sakabe K, Onose Y, Sawada Y, Tamura Y (2002) Mitral inflow and mitral annular motion velocities in patients with mitral annular calcification: evaluation by pulsed Doppler echocardiography and pulsed Doppler tissue imaging. Eur J Echocardiogr 3:128–134. https://doi.org/10.1053/euje.2001.0137

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3