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Compromised left atrial function and increased size predict raised cavity pressure: a systematic review and

Ibadete Bytyçi1,2,3,4, Gani Bajraktari1,2,3, Per Lindqvist5

  • 1Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Clinical Physiology and Functional Imaging
|May 29, 2019
PubMed

Insights

Left atrial size and function predict elevated pulmonary capillary wedge pressure (PCWP). Peak atrial longitudinal strain (PALS) and peak atrial contraction (PACS) strain are strong predictors of PCWP, aiding patient management.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Accuracy

Background:

  • Pulmonary capillary wedge pressure (PCWP) is a key indicator of left atrial pressure.
  • Accurate prediction of PCWP is crucial for managing cardiovascular conditions.
  • Non-invasive methods for assessing PCWP are highly sought after.

Purpose of the Study:

  • To systematically evaluate left atrial (LA) cavity and myocardial function measurements as predictors of PCWP.
  • To determine the diagnostic accuracy of various LA indices in identifying elevated PCWP.
  • To identify optimal cut-off values for LA parameters in predicting PCWP.

Main Methods:

  • A comprehensive literature search was conducted across major databases (PubMed, EMBASE, Scopus, Google Scholar, Cochrane).
  • Eighteen studies involving 1343 patients were included in the meta-analysis.
  • Summary receiver operating characteristic (SROC) analysis was used to estimate diagnostic accuracy and optimal cut-off values.

Main Results:

  • Significant associations were found between PCWP and LA diameter, LAVI max, and LAVI min.
  • Stronger correlations were observed between PCWP and peak atrial longitudinal strain (PALS), peak atrial contraction (PACS) strain, and total emptying fraction (LAEF).
  • PALS ≤19% demonstrated a summary sensitivity of 80% and specificity of 77%; LAVI ≥34 ml/m² showed 75% sensitivity and 77% specificity.

Conclusions:

  • Compromised LA myocardial function and increased LA size are reliable predictors of elevated PCWP.
  • LA strain parameters (PALS, PACS) and LA volume indices (LAVI) offer valuable non-invasive assessment of PCWP.
  • These findings can guide optimal follow-up strategies for patients with fluctuating LA pressures.
Abstract

Keywords:
left atrialleft atrial functionleft atrial sizeleft atrial strainpulmonary capillary wedge pressure

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