title: Left atrial strain: a new parameter for assessment of left ventricular filling pressure.
abstract: In order to obtain accurate diagnosis, treatment and prognostication in many cardiac conditions, there is a need for assessment of left ventricular (LV) filling pressure. While systole depends on ejection function of LV, diastole and its disturbances influence filling function and pressures. The commonest condition that represents the latter is heart failure with preserved ejection fraction in which LV ejection is maintained, but diastole is disturbed and hence filling pressures are raised. Significant diastolic dysfunction results in raised LV end-diastolic pressure, mean left atrial (LA) pressure and pulmonary capillary wedge pressure, all referred to as LV filling pressures. Left and right heart catheterization has traditionally been used as the gold standard investigation for assessing these pressures. More recently, Doppler echocardiography has taken over such application because of its noninvasive nature and for being patient friendly. A number of indices are used to achieve accurate assessment of filling pressures including: LV pulsed-wave filling velocities (E/A ratio, E wave deceleration time), pulmonary venous flow (S wave and D wave), tissue Doppler imaging (E' wave and E/E' ratio) and LA volume index. LA longitudinal strain derived from speckle tracking echocardiography (STE) is also sensitive in estimating intracavitary pressures. It is angle-independent, thus overcomes Doppler limitations and provides highly reproducible measures of LA deformation. This review examines the application of various Doppler echocardiographic techniques in assessing LV filling pressures, in particular the emerging role of STE in assessing LA pressures in various conditions, e.g., HF, arterial hypertension and atrial fibrillation.
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 1, 53100, Siena, Italy. matteo.cameli@yahoo.com.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 1, 53100, Siena, Italy.
authors.forename: Giulia Elena
authors.initials: GE
authors.lastname: Mandoli
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 1, 53100, Siena, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Loiacono
authors.affiliation: Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
authors.affiliation: Department of Public Health and Clinical Medicine, University of Umeå and Heart Centre, Umeå, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Henein
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 1, 53100, Siena, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
mesh_terms: D015150:Echocardiography, Doppler / Q000379:methods*; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D015203:Reproducibility of Results; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology
keywords: Echocardiography; Left atrium; Left ventricular filling pressure; Speckle tracking; Strain