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

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.