title: Left Atrial Intrinsic Strain Rate Correcting for Pulmonary Wedge Pressure Is Accurate in Estimating Pulmonary Vascular Resistance in Breathless Patients.
abstract: OBJECTIVE
  We hypothesized that left atrial deformation during atrial systole (LASRa) correlates with pulmonary capillary wedge pressure (PCWP), thus enabling echo-derived pulmonary vascular resistance (PVR) estimation in a wide range of different subsets of patients.
  
  
  BACKGROUND
  Various etiologies of pulmonary hypertension (PH) have different mechanisms and treatments for breathlessness. Irrespective of the location of the underlying pulmonary vascular pathology, pre- or postcapillary, the resulting PH is fairly easy to assess by Doppler echocardiography, but PVR remains a challenge.
  
  
  METHODS
  We prospectively included 46 patients (mean age 61 ± 13 years) in sinus rhythm, who underwent right heart catheterization because of dyspnea. According to the NICE guidelines classification, 22 belonged to group 1 pulmonary artery hypertension (PAH), 19 belonged to group 2 congestive heart failure (CHF), 1 belonged to group 4 chronic thromboembolic pulmonary hypertension (CTEPH), and 4 had normal hemodynamics. Simultaneous Doppler echocardiography using spectral, tissue Doppler, and speckle tracking echocardiography techniques for assessing LA structure and function was performed.
  
  
  RESULTS
  PCWPrhc correlated with LASRa (r(2) = 0.65, P < 0.001). PCWPecho was calculated using the equation (PCWPecho = 26.12 - 11.09 × LASRa), and the resulting PVR echo strongly correlated with the respective catheter-based measurements PVRrhc (r(2) = 0.69. P < 0.001) with a sensitivity of 85% and specificity of 74% identifying a PVR ≥ 3 WU.
  
  
  CONCLUSIONS
  Left atrial strain rate during atrial systole correlates closely with pulmonary capillary wedge pressure and consequently the calculated pulmonary vascular resistance, irrespective of the etiology of PH.
authors.affiliation: Department of Cardiology, Heart Center, Umeå University, Umeå, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Tossavainen
authors.affiliation: Department of Cardiology, Heart Center, Umeå University, Umeå, Sweden.|Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Henein
authors.affiliation: Department of Biomedical Engineering - R&D Radiation Sciences, Umeå University, Umeå, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Grönlund
authors.affiliation: Department of Clinical Physiology, Heart Center, Umeå University, Umeå, Sweden.|Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Lindqvist
mesh_terms: D001795:Blood Pressure Determination / Q000379:methods; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014655:Vascular Resistance
keywords: echocardiography; left atrium; strain rate