title: Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure.
abstract: BACKGROUND
  The combination of early transmitral inflow velocity and mitral annular tissue Doppler imaging (E/Em ratio) is widely applied to noninvasively estimate left ventricular (LV) filling pressures. However E/Em ratio has a significant gray zone and its accuracy in patients with heart failure is debated. Left atrial (LA) deformation analysis by speckle tracking echocardiography (STE) was recently proposed as an alternative approach to estimate LV filling pressures. This study aimed at exploring the correlation of LA longitudinal function by STE and Doppler measurements with direct measurements of LV filling pressures in patients with heart failure.
  
  
  METHODS
  A total of 36 patients with advanced systolic heart failure (ejection fraction < or = 35%), undergoing right heart catheterization, were studied. Simultaneously to pulmonary capillary wedge pressure (PCWP) determination, peak atrial longitudinal strain (PALS) and mean E/Em ratio were measured in all subjects by two independent operators. PALS values were obtained by averaging all segments (global PALS), and by separately averaging segments measured in the 4-chamber and 2-chamber views.
  
  
  RESULTS
  Not significant correlation was found between mean E/Em ratio and PCWP (R = 0.15). A close negative correlation between global PALS and the PCWP was found (R = -0.81, p < 0.0001). Furthermore, global PALS demonstrated the highest diagnostic accuracy (AUC of 0.93) and excellent sensitivity and specificity of 100% and 93%, respectively, to predict elevated filling pressure using a cutoff value less than 15.1%. Bland-Altman analysis confirmed this close agreement between PCWP estimated by global PALS and invasive PCWP (mean bias 0.1 +/- 8.0 mmHg).
  
  
  CONCLUSIONS
  In a group of patients with advanced systolic heart failure, E/Em ratio correlated poorly with invasively obtained LV filling pressures. However, LA longitudinal deformation analysis by STE correlated well with PCWP, providing a better estimation of LV filling pressures in this particular clinical setting.
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Siena, Italy. cameli@cheapnet.it
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.forename: Matteo
authors.initials: M
authors.lastname: Lisi
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
authors.forename: Margherita
authors.initials: M
authors.lastname: Padeletti
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Ballo
authors.forename: Charilaos
authors.initials: C
authors.lastname: Tsioulpas
authors.forename: Sonia
authors.initials: S
authors.lastname: Bernazzali
authors.forename: Massimo
authors.initials: M
authors.lastname: Maccherini
mesh_terms: D000368:Aged; D016279:Atrial Function, Left; D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler / Q000379:methods* / Q000592:standards*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D015203:Reproducibility of Results; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017725:Ventricular Pressure
references.citation: Am J Cardiol. 2001 May 15;87(10):1213-5; A7
references.pmid: 11356404
references.citation: J Am Soc Echocardiogr. 2009 Jul;22(7):847-51
references.pmid: 19560662
references.citation: Can J Cardiol. 2007 Oct;23(12):983-9
references.pmid: 17932575
references.citation: J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63
references.pmid: 16376782
references.citation: Am J Cardiol. 1988 Jan 1;61(1):136-41
references.pmid: 3337002
references.citation: Circulation. 2000 Oct 10;102(15):1788-94
references.pmid: 11023933
references.citation: J Am Soc Echocardiogr. 2009 Mar;22(3):299-305
references.pmid: 19258177
references.citation: Circulation. 2007 Mar 20;115(11):1376-83
references.pmid: 17339549
references.citation: Circulation. 2005 Jun 21;111(24):3192-4
references.pmid: 15967860
references.citation: Am J Cardiol. 2006 Jan 1;97(1):83-9
references.pmid: 16377289
references.citation: Circulation. 1972 Aug;46(2):283-90
references.pmid: 5046023
references.citation: Lancet. 1986 Feb 8;1(8476):307-10
references.pmid: 2868172
references.citation: Am J Cardiol. 2008 May 15;101(10):1504-9
references.pmid: 18471466
references.citation: Circulation. 1999 Jan 19;99(2):254-61
references.pmid: 9892592
references.citation: Am J Cardiol. 2003 Mar 15;91(6):780-4
references.pmid: 12633827
references.citation: J Am Coll Cardiol. 1999 Jul;34(1):90-4
references.pmid: 10399996
references.citation: Am J Med. 1964 Jul;37:36-43
references.pmid: 14181147
references.citation: Cardiovasc Ultrasound. 2009 Feb 08;7:6
references.pmid: 19200402
references.citation: Circulation. 1998 Oct 20;98(16):1644-50
references.pmid: 9778330
references.citation: J Am Coll Cardiol. 2007 May 15;49(19):1903-14
references.pmid: 17498573
references.citation: Circ Res. 1953 Jul;1(4):337-9
references.pmid: 13059878
references.citation: Am J Cardiol. 1990 Apr 1;65(13):903-8
references.pmid: 2138849
references.citation: J Am Soc Echocardiogr. 2002 Feb;15(2):167-84
references.pmid: 11836492
references.citation: Circulation. 2005 Jun 21;111(24):3281-9
references.pmid: 15956127
references.citation: J Am Coll Cardiol. 1997 Nov 15;30(6):1527-33
references.pmid: 9362412
references.citation: J Thorac Cardiovasc Surg. 2010 Oct;140(4):807-15
references.pmid: 20117802
references.citation: Am J Cardiol. 1999 Apr 1;83(7):1027-32
references.pmid: 10190514
references.citation: Echocardiography. 2009 Nov;26(10):1179-87
references.pmid: 19725856
references.citation: Circulation. 2009 Jan 6;119(1):62-70
references.pmid: 19075104
references.citation: J Am Soc Echocardiogr. 2010 Feb;23(2):172-80
references.pmid: 20152699
references.citation: Crit Care. 2008;12(1):R18
references.pmid: 18284668
references.citation: J Am Coll Cardiol. 1995 Nov 15;26(6):1417-23
references.pmid: 7594064
references.citation: Circulation. 2004 May 25;109(20):2432-9
references.pmid: 15123522
references.citation: Circulation. 2007 Aug 7;116(6):637-47
references.pmid: 17646587