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Left Atrial Strain: have we found the missing piece of the puzzle?
Session:
Painel 3 - Imagiologia Cardiovascular 3
Speaker:
Nelson Ribeiro
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Nelson Ribeiro; João André Ferreira; Patrícia Pinheiro Paiva; Cátia Santos Ferreira; André Azul; Valdirene Gonçalves; Ana Paula Oliveira; Rogerio Teixeira; Graça Castro; Lino Gonçalves
Abstract
<p><strong>Background: </strong>The 2016 Guidelines for the evaluation of left ventricular (LV) diastolic function opens possibility for the use of new technologies that support the diagnostic process. The persistence of a “gray zone” of values in which DD quantification is not possible, together with an epidemiological increase of conditions predisposing to heart failure with preserved ejection fraction (HFpEF), has led to the search and use of parameters with higher specificity and sensitivity: one of these is left atrial (LA) reservoir phase strain (e<sub>R</sub>) assessed with 2D speckle tracking echocardiography (2D-STE). A new parameter is introduced, the dependent strain, which quantifies LA reservoir phase deformation during.</p> <p><strong>Aims:</strong> To evaluate if e<sub>R</sub> can identify subclinical atrial myocardial damage and to study its associaton with DD by standard diagnosis criteria.</p> <p><strong>Material and Methods:</strong> We retrospectively analysed data from 99 patients referred transthoracic echocardiography for arterial hypertension. LA reservoir phase deformation was deformation was evaluated with 2D-STE and LA volumes were calculated with 2D-echocardiography. DD was defined when patients had at least 3 positive parameters of the following (average E/e’ >14, septal e’ velocity <7 cm/s or lateral e’ velocity <10 cm/s, tricuspid regurgitation maximum velocity >2.8 m/s and LA volume >34 mL/m2). Patients satisfying only 2 the parameters were classified as having “indeterminate DD”.</p> <p><strong>Results:</strong> In our cohort, 19.2% (n=19) were deemed to have normal diastolic function, 40.4% (n=40) were classified as indeterminate DD and 40.4% (n=40) as having DD. In normal patients the indexed LA volume was lower when compared to indeterminate DD or DD (26,5±3.6 vs. 35,9±7.0vs. 42.4±10.5mL/m2, P<0.01, respectively) as well as average E/e’ (7.5±1.6 vs. 14.8±21.4 vs. 17.4±5.1, P=0.044, respectively) and maximum tricuspid regurgitation velocities (18.3±1.5 vs. 22.0±4.2 vs. 31.4±8.3m/s, P<0.001, respectively). On the other side, e’ septal velocities (10±1.5 vs. 4.8±1.7 vs. 5.2±1.1cm/s, P<0.001, respectively) and e’ lateral velocities (12±1.7 vs. 6.5±1.9 vs. 6.3±1.3cm/s, P<0.001, respectively) were higher in normal patients when compared to indeterminate DD and DD. e<sub>R </sub>was higher in normal patients when compared to indeterminate DD and DD (39.8±10.2 vs. 23.9±6.8 vs. 18.8±6.5%, P<0.001, respectively). Receiver operating characteristic curve analysis showed that the under the curve of reservoir phase for diastolic dysfunction according to 2016 guidelines was 0.79 (AUC=0.79, CI 95% 0.70-0,88, P<0.001). For a e<sub>R </sub>value of 35%, sensitivity was 100% and specificity was 25.4%. On the other side, for a e<sub>R </sub>of 15%, sensitivity was 27.5% and specificity was 100%.</p> <p><strong>Conclusion:</strong> LA strain could help re-classify DD in patients falling in the indeterminate range according to 2016 criteria. Further evidence is needed to investigate its role as a lone index for the same purpose.</p>
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