Noroozi Maryam, Khalilipur Ehsan, Baay Mohammadreza, Khesali Hamideh, Bakhshandeh Hooman, Cheraghi Saeed, Salehi Ebrahim, Salmannejad Reza, Emami Elahe, Farrashi Melody
Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
J Tehran Heart Cent. 2024;19(Suppl 1):24-31. doi: 10.18502/jthc.v19is1.18476.
The noninvasive estimation of elevated left ventricular end-diastolic pressure (LVEDP) is a critical step in assessing left ventricular diastolic dysfunction (LVDD). Nonetheless, most echocardiographic parameters currently used for this purpose have significant limitations. Recent studies have highlighted the utility of left atrial (LA) strain as a noninvasive method for estimating LVEDP. This study aimed to explore the correlations between LA deformation parameters, measured using speckle-tracking echocardiography (STE), and invasively obtained LVEDP.
This prospective study involved 82 patients in sinus rhythm who underwent left heart catheterization at our center. All participants underwent comprehensive transthoracic echocardiography and peak atrial longitudinal strain (PALS) assessment via STE within 12 hours before catheterization.
LVEDP was elevated in 45 patients (54.9%) and normal in 37 (45.1%). PALS, LA ejection fraction, and septal E' showed moderate inverse correlations with LVEDP (r= -0.590, P=0.001; r= -0.463, P=0.001; and r= -0.449, P=0.001, respectively). The E/E' ratio also exhibited a moderate correlation with LVEDP (r=0.567, P=0.001). Lateral E' and the E/A ratio demonstrated weaker inverse correlations with LVEDP (r= -0.231, P=0.037 and r= -0.229, P=0.038, respectively). In multivariate logistic regression analysis, age (OR, 1.14, 95% CI, 1.02 to 1.27), PALS (OR, 0.77, 95% CI, 0.65 to 0.91), and the E/E' ratio (OR, 1.36, 95% CI, 1.11 to 1.89) were identified as independent predictors of an LVEDP≥12 mm Hg. PALS demonstrated the highest diagnostic accuracy for predicting an LVEDP≥12 mm Hg, with an AUC of 0.849 (95% CI, 0.764 to 0.935; P<0.001). A PALS cutoff value of 35% yielded a sensitivity of 81.1% and a specificity of 81.4% for predicting elevated LVEDP.
PALS emerged as a reliable noninvasive parameter for predicting elevated LVEDP. Its application may facilitate the earlier identification of LVDD.
左心室舒张末压（LVEDP）升高的无创估算是评估左心室舒张功能障碍（LVDD）的关键步骤。然而，目前用于此目的的大多数超声心动图参数都有显著局限性。最近的研究强调了左心房（LA）应变作为估算LVEDP的无创方法的实用性。本研究旨在探讨使用斑点追踪超声心动图（STE）测量的LA变形参数与有创获得的LVEDP之间的相关性。
这项前瞻性研究纳入了82例窦性心律患者，他们在我们中心接受了左心导管检查。所有参与者在导管检查前12小时内接受了全面的经胸超声心动图检查，并通过STE评估了心房纵向峰值应变（PALS）。
45例患者（54.9%）的LVEDP升高，37例（45.1%）正常。PALS、LA射血分数和室间隔E'与LVEDP呈中度负相关（r分别为-0.590，P = 0.001；r = -0.463，P = 0.001；r = -0.449，P = 0.001）。E/E'比值也与LVEDP呈中度相关（r = 0.567，P = 0.001）。侧壁E'和E/A比值与LVEDP的负相关性较弱（r分别为-0.231，P = 0.037和r = -0.229，P = 0.038）。在多因素逻辑回归分析中，年龄（OR，1.14，95%CI，1.02至1.27）、PALS（OR，0.77，95%CI，0.65至0.91）和E/E'比值（OR，1.36，95%CI，1.11至1.89）被确定为LVEDP≥12 mmHg的独立预测因素。PALS对预测LVEDP≥12 mmHg的诊断准确性最高，AUC为0.849（95%CI，0.764至0.935；P<0.001）。预测LVEDP升高的PALS临界值为35%时，敏感性为81.1%，特异性为81.4%。
PALS是预测LVEDP升高的可靠无创参数。其应用可能有助于更早地识别LVDD。
