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Left Atrial Intrinsic Strain Rate Correcting for Pulmonary Wedge Pressure Is Accurate in Estimating Pulmonary Vascular Resistance in Breathless Patients
Author(s) -
Tossavainen Erik,
Henein Michael Y.,
Grönlund Christer,
Lindqvist Per
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13226
Subject(s) - pulmonary wedge pressure , medicine , cardiology , pulmonary hypertension , vascular resistance , pulmonary artery , heart failure , sinus rhythm , systole , hemodynamics , blood pressure , atrial fibrillation , diastole
Objectives We hypothesized that left atrial deformation during atrial systole ( LASR a) correlates with pulmonary capillary wedge pressure ( PCWP ), thus enabling echo‐derived pulmonary vascular resistance ( PVR ) estimation in a wide range of different subsets of patients. Background Various etiologies of pulmonary hypertension ( PH ) have different mechanisms and treatments for breathlessness. Irrespective of the location of the underlying pulmonary vascular pathology, pre‐ or postcapillary, the resulting PH is fairly easy to assess by Doppler echocardiography, but PVR remains a challenge. Methods We prospectively included 46 patients (mean age 61 ± 13 years) in sinus rhythm, who underwent right heart catheterization because of dyspnea. According to the NICE guidelines classification, 22 belonged to group 1 pulmonary artery hypertension ( PAH ), 19 belonged to group 2 congestive heart failure ( CHF ), 1 belonged to group 4 chronic thromboembolic pulmonary hypertension ( CTEPH ), and 4 had normal hemodynamics. Simultaneous Doppler echocardiography using spectral, tissue Doppler, and speckle tracking echocardiography techniques for assessing LA structure and function was performed. Results PCWP rhc correlated with LASR a (r 2 = 0.65, P < 0.001). PCWP echo was calculated using the equation ( PCWP echo = 26.12 − 11.09 × LASR a), and the resulting PVR echo strongly correlated with the respective catheter‐based measurements PVR rhc (r 2 = 0.69. P < 0.001) with a sensitivity of 85% and specificity of 74% identifying a PVR ≥ 3 WU . Conclusions Left atrial strain rate during atrial systole correlates closely with pulmonary capillary wedge pressure and consequently the calculated pulmonary vascular resistance, irrespective of the etiology of PH .