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Left atrial strain: a new parameter for assessment of left ventricular filling pressure
Matteo Cameli1, Giulia Elena Mandoli2, Ferdinando Loiacono2
1Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 1, 53100, Siena, Italy. matteo.cameli@yahoo.com.
Insights
Accurate assessment of left ventricular (LV) filling pressures is crucial for cardiac conditions. Doppler echocardiography, especially speckle tracking echocardiography (STE), offers a noninvasive method to evaluate these pressures, improving diagnosis and treatment.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- Accurate assessment of left ventricular (LV) filling pressure is vital for diagnosing and managing cardiac conditions, particularly heart failure with preserved ejection fraction.
- Diastolic dysfunction, characterized by impaired LV filling, leads to elevated LV end-diastolic pressure, mean left atrial (LA) pressure, and pulmonary capillary wedge pressure.
- Traditional methods like cardiac catheterization are invasive; Doppler echocardiography offers a noninvasive alternative for evaluating LV filling pressures.
Purpose of the Study:
- To review the application of various Doppler echocardiographic techniques for assessing LV filling pressures.
- To highlight the emerging role of speckle tracking echocardiography (STE) in estimating LA pressures.
- To discuss the utility of these echocardiographic methods in conditions such as heart failure, arterial hypertension, and atrial fibrillation.
Main Methods:
- Review of existing literature on Doppler echocardiography and speckle tracking echocardiography (STE) for assessing LV filling pressures.
- Discussion of various echocardiographic indices including LV pulsed-wave filling velocities (E/A ratio, deceleration time), pulmonary venous flow, tissue Doppler imaging (E' wave, E/E' ratio), and LA volume index.
- Focus on the application and advantages of STE for measuring LA strain and estimating pressures.
Main Results:
- Doppler echocardiography provides multiple noninvasive indices for evaluating LV filling pressures.
- Speckle tracking echocardiography (STE) offers angle-independent and reproducible measures of LA deformation, proving sensitive for estimating intracavitary pressures.
- STE demonstrates significant potential in assessing LA pressures across various cardiovascular conditions.
Conclusions:
- Doppler echocardiography is a valuable noninvasive tool for assessing LV filling pressures.
- Speckle tracking echocardiography (STE) represents a promising advancement in accurately estimating LA pressures, complementing traditional Doppler methods.
- These echocardiographic techniques are essential for the comprehensive evaluation and management of patients with diastolic dysfunction and related cardiac conditions.
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.
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