umu.sePublications
Change search
ReferencesLink to record
Permanent link

Direct link
Reduced myocardial strain is the best predictor of left atrial fibrosis and symptoms in patients undergoing heart transplantation
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Cardiovascular Disease, University of Siena, Italy. (Cardiology)
Department of Cardiovascular Disease, University of Siena, Italy.
Department of Cardiovascular Disease, University of Siena, Italy.
Department of Cardiovascular Disease, University of Siena, Italy.
Show others and affiliations
2016 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Left ventricular systolic dysfunction and raised diastolic pressures contribute to progressive left atrial (LA). We aimed to assess LA peak atrial longitudinal strain (PALS), in predicting the extent of LA fibrosis in patients with end-stage heart failure (HF) undergoing heart transplantation (HTx).

Methods: We studied 48 patients with severe systolic HF (EF≤25% and NYHA class III-IV) before HTx. PALS, LA volume and LA stiffness were all measured. From the LA myocardial histological analysis, the ratio of fibrotic to total sample area determined the extent of fibrosis (%). Right heart catheterization and cardiopulmonary exercise testing were also assessed.

 

Results: LA fibrosis correlated strongly with PALS (R=-0.76; p<0.0001) and NYHA class (R=0.73; p<0.0001) and to a lesser extent with VO2 max (R=-0.65; p=0.001), LA stiffness (R=0.58; p=0.001), PAoP (R=0.51; p=0.03), E/e′ (R=0.55; p=0.01) and E/A (R=0.46; p=0.01). Global PALS correlated modestly with VO2 max (R=0.53; p=0.001) and LA volume (R=-0.48; p=0.01) and weakly with E/e′ (R=-0.36; p=0.03). Multivariate regression analysis identified global PALS as the main determinant of LA myocardial fibrosis (β =-0.62, p<0.001). A cut off value of 7.6% gave an AUC of 0.79 on the ROC curve with a sensitivity of 87% and specificity of 84% in predicting >50% myocardial fibrosis.

Conclusions:LA PALS is the most accurate LA function parameter that correlates with the extent of myocardial fibrosis in patients with advanced systolic HF requiring HTx.PALS of 7.6% could be used as a cut off value for identifying patients with severe LA fibrosis.

Place, publisher, year, edition, pages
2016.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-127292OAI: oai:DiVA.org:umu-127292DiVA: diva2:1044686
Available from: 2016-11-04 Created: 2016-11-04 Last updated: 2016-11-09
In thesis
1. Insights into left atrial response to pressure and volume overload
Open this publication in new window or tab >>Insights into left atrial response to pressure and volume overload
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general purpose of this thesis is to establish the ability of Speckle Tracking Echocardiography (STE) in assessing left atrial (LA) response to pressure and volume overload respectively in aortic stenosis (AS) and mitral regurgitation (MR), and to evaluate its accuracy in predicting LA and right ventricular (RV) fibrosis in patients with end-stage heart failure (HF) undergoing heart transplantation (HTx).

I demonstrated that assessment of left ventricular (LV) long axis systolic velocity and amplitude of excursion is more sensitive than simple determination of ejection fraction (EF) for revealing the beneficial impact of MR surgery on overall LV systolic performance.

Severe symptomatic AS is associated with LA enlargement and compromised mechanical function with a high incidence of peri-operative atrial fibrillation (AF). Valve replacement reverses these abnormalities and regains normal atrial function, a behaviour which is directly related to the severity of pre-operative LV outflow tract obstruction. Early identification of LA size and function disturbances, as shown by myocardial strain measurements might contribute to better patient’s recruitment for a safe valve replacement.

In late stage HF patients, the right ventricle is enlarged, with reduced systolic function due to significant myocardial fibrosis. RV free wall myocardial deformation is the most accurate function measure that correlates with the extent of RV myocardial fibrosis and functional capacity.

In patients with preserved EF, severe MR masks LV and LA myocardial dysfunction and correlates with symptoms and post-operative cavity function instability. Three months after MVR, the underlying myocardial disturbances are unmasked suggesting that most pre-operative measurements are subject to loading conditions. Finally LA volume and PALS remain the main predictors of post-operative AF, thus should be used for stratifying surgical risk.

STE has been shown to accurately determine the severity of impairment of LA myocardial function shown by suppressed PALS which was the strongest predictor of the presence and extent of fibrosis, over and above other structure and function parameters. These findings may assist in better stratifying patients with end stage HF and identifying particularly those requiring HTx.

Place, publisher, year, edition, pages
Umeå: University of Umeå, 2016. 138 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1863
Keyword
Keywords Mitral regurgitation, aortic stenosis, speckle tracking echocardiography, heart transplantation, left atrial strain, left ventricualr function, right ventricular function, myocardial fibrosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-127294 (URN)978-91-7601-610-7 (ISBN)
Public defence
2016-12-01, Sal C, Unod T9, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2016-11-10 Created: 2016-11-04 Last updated: 2016-11-21Bibliographically approved

Open Access in DiVA

No full text

Search in DiVA

By author/editor
Lisi, MatteoCameli, MatteoLindqvist, PerHenein, Michael
By organisation
Department of Public Health and Clinical Medicine
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

Total: 9 hits
ReferencesLink to record
Permanent link

Direct link