Non-invasive Estimation of Left Ventricular Filling Pressure Based on Left Atrial Area Strain Measured with Transthoracic 3D Speckle Tracking Echocardiography in Patients with Coronary Artery Disease

概要

Background: Chronic elevation of left ventricular (LV) diastolic pressure (DP) or chronic elevation of left atrial (LA) pressure, which is required to maintain LV filling, may determine LA wall deformation. We investigated this issue using transthoracic 3-dimensional speckle tracking echocardiography (3D-STE).

Methods: We retrospectively enrolled 75 consecutive patients with sinus rhythm and suspicious stable coronary artery disease that underwent diagnostic cardiac catheterization and 3D-STE on the same day. We computed the global LA wall area change ratio, termed the global LA area strain (GLAS), during both reservoir phase (GLAS-r) and contraction phase (GLAS-ct). The LVDP at end-diastole (LVEDP) and the mean (mLVDP) were measured with a catheter-tipped micromanometer in each patient.

Results: The GLAS-r and GLAS-ct were significantly correlated with both the mLVDP (r=-0.70, P<0.001 and r=0.71, P<0.001, respectively) and the LVEDP (r=-0.63, P<0.001 and r=0.65, P<0.001, respectively). In a receiver operating characteristic curve analysis, the optimal cutoff values for diagnosing an elevated LVEDP (≥16 mmHg) were 75.7% (sensitivity 83.3% and specificity 77.8%) for GLAS-r and -43.1% (sensitivity 90.0% and specificity 80.0%) for GLAS-ct. Similarly, for diagnosing an elevated mLVDP (≥12 mmHg), the cutoffs were 63.6% (sensitivity 88.9% and specificity 80.3%) for GLAS-r and -26.2% (sensitivity 66.7% and specificity 97.0%) for GLAS-ct.

Conclusion: We showed that 3D-STE–derived GLAS values could serve to diagnose elevated LV filling pressure non-invasively.