Department of Surgical and Perioperative Sciences and Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Int J Cardiovasc Imaging. 2021 May;37(5):1529-1538. doi: 10.1007/s10554-020-02126-7. Epub 2021 Jan 3.
This study aimed to assess the relationship between different LA strain components and PCWP as well as to the relationship with other established methods. We studied 144 symptomatic patients, age 63 ± 14 years, 54 males, using conventional transthoracic echocardiography protocols, including LA and LV myocardial deformation from speckle tracking technique investigations along with simultaneous right heart catheterization (RHC) using established techniques. From RHC, pulmonary artery pressure (PAP), and pulmonary capillary wedge pressure (PCWP) were measured and pulmonary vascular resistance (PVR) calculated. LA strain rate during atrial contraction (LASRa) was the strongest correlate with PCWP (r = - 0.40, p < 0.001), over and above both LASR during LV systole (LASRs) and LA longitudinal strain during ventricular systole (LASs) (r = 0.21 and 0.19, respectively, p < 0.001 for both). The correlation between LASRa and PCWP was stronger in patients with post-capillary PH compared to pre-capillary PH (r = 0.21 vs. r = 0.02, respectively). The strongest relationship between LASRa and PCWP was in patients with enlarged LA volume > 34 ml/m (r = 0.60, p < 0.001). In all patients LASRa < = 0.9 1/s was 88% accurate in predicting LA pressure > 15 mmHg which was superior to recently proposed uni- and multi-variable models. LASR during atrial contraction is the strongest predictor of PCWP, particularly in patients with post-capillary PH and with dilated LA cavity. Furthermore, it proved superior to recently proposed uni- and multi-variable based algorithms. Its close relationship with LV strain rate counterpart reflects important left heart chamber interaction in patients with raised LA pressure.
本研究旨在评估不同左心房应变分量与肺毛细血管楔压（PCWP）之间的关系以及与其他已建立方法的关系。我们研究了 144 名有症状的患者，年龄 63±14 岁，54 名男性，使用常规经胸超声心动图方案，包括斑点追踪技术评估的左心房和左心室心肌应变，同时使用已建立的技术进行右心导管检查（RHC）。从 RHC 测量肺动脉压（PAP）和肺毛细血管楔压（PCWP），并计算肺血管阻力（PVR）。左心房收缩期应变率（LASRa）与 PCWP 的相关性最强（r=-0.40，p<0.001），超过左心室收缩期 LASR（LASRs）和左心室收缩期左心房纵向应变（LASs）（r 分别为 0.21 和 0.19，均为 p<0.001）。与前毛细血管 PH 相比，后毛细血管 PH 患者的 LASRa 与 PCWP 的相关性更强（r=0.21 与 r=0.02，分别为 p<0.001）。在左心房容积大于 34ml/m2 的患者中，LASRa 与 PCWP 之间的关系最强（r=0.60，p<0.001）。在所有患者中，LASRa< =0.9 1/s 预测左心房压> 15mmHg 的准确率为 88%，优于最近提出的单变量和多变量模型。心房收缩期 LASR 是 PCWP 的最强预测因子，尤其是在后毛细血管 PH 和左心房腔扩张的患者中。此外，它优于最近提出的单变量和多变量基于算法。它与左心室应变率对应物的密切关系反映了左心房压力升高患者左心室内腔的重要相互作用。
