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Compromised left atrial function and increased size predict raised cavity pressure: a systematic review and meta‐analysis
Author(s) -
Bytyçi Ibadete,
Bajraktari Gani,
Lindqvist Per,
Henein Michael Y.
Publication year - 2019
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12587
Subject(s) - medicine , pulmonary wedge pressure , cardiology , meta analysis , confidence interval , publication bias , blood pressure
Summary Aim This meta‐analysis assesses left atrial ( LA ) cavity and myocardial function measurements that predict pulmonary capillary wedge pressure ( PCWP ). Methods PubMed– MEDLINE , EMBASE , Scopus, Google Scholar and the Cochrane Central Registry were searched up to December 2018 for studies on the relationship of LA diameter, LA indexed volume ( LAVI max, LAVI min), peak atrial longitudinal ( PALS ), peak atrial contraction ( PACS ) strain and total emptying fraction ( LAEF ) with PCWP . Eighteen studies with 1343 patients were included. Summary sensitivity and specificity (with 95% CI ) for evaluation of diagnostic accuracy and the best cut‐off values for different LA indices in predicting raised PCWP were estimated using summary receiver operating characteristic analysis. Results The pooled analysis showed association between PCWP and LA diameter: Cohen's d = 0·87, LAVI max: d = 0·92 and LAVI min: d = 1·0 ( P <0·001 for all). A stronger correlation was found between PCWP and PALS : d = 1·26, and PACS : d = 1·62, total EF d = 1·22 ( P <0·0001 for all). PALS ≤19% had a summary sensitivity of 80% (65–90) and summary specificity of 77% (52–92), positive likelihood ratio ( LR +) 3·74, negative likelihood ratio ( LR ‐) <0·25 and DOR > 15·1 whereas LAVI ≥34 ml m −2 had summary sensitivity of 75% (55–89) and summary specificity 77% (57–90), with LR + >3, LR ‐ 0·32 and DOR >10·1. Conclusions Compromised LA myocardial function and increased size predict raised cavity pressure. These results should assist in optimum follow‐up of patients with fluctuating LA pressure.