Improving the assessment of left ventricular diastolic dysfunction by including left atrial strain in the algorithm: LA Strain and LV diastolic dysfunction assessment.

IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiac Failure Pub Date : 2024-10-30 DOI:10.1016/j.cardfail.2024.08.064
Lin Wang, Jonathan Weber, Jason Craft, Michael Passick, Omar K Khalique, Ziad A Ali, Jae K Oh, J Jane Cao
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Abstract

Background: The latest guidelines on echocardiographic assessment of left ventricular diastolic dysfunction (LVDD) leave a significant proportion of patients with LVDD status undetermined. We aimed to examine the implication of an alternative algorithm incorporating left atrial (LA) strain as a tiebreaker on the indeterminate LVDD category.

Methods and results: We included 823 patients who underwent echocardiography and cardiac MRI within 7 days. LVDD was assessed by echocardiography following contemporary guidelines and an alternative algorithm including LA reservoir strain as a tie-breaker. LVDD was examined for its association with LV myocardial scar burden by cardiac MRI, and a composite outcome. 275 (33%) patients had LVDD, of whom 119 had advanced grades of LVDD (grade II-III), and 117 (14%) had indeterminate LVDD grade. When LA strain was applied at cut points of 18%, 24% and 35%, subjects were reclassified as normal or LVDD dependent accordingly. Reclassification allowed a similar outcome risk-stratification as the current guidelines.

Conclusions: LA reservoir strain improved LVDD assessment by eliminating indeterminate status/grade while maintaining the same effective outcome stratification as current guidelines.

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将左心房应变纳入算法,改进左心室舒张功能障碍的评估:LA 应变和左心室舒张功能障碍评估。
背景:最新的左心室舒张功能障碍(LVDD)超声心动图评估指南使相当一部分患者的 LVDD 状态未确定。我们旨在研究将左心房(LA)应变作为不确定 LVDD 类别的决定因素的替代算法的影响:我们纳入了 823 名在 7 天内接受超声心动图和心脏磁共振成像检查的患者。超声心动图评估 LVDD 时遵循了当代指南和一种替代算法,其中包括将 LA 储层应变作为平局判定标准。通过心脏磁共振成像检查 LVDD 与左心室心肌瘢痕负担的关系,并得出综合结果。275例(33%)患者患有LVDD,其中119例为晚期LVDD(II-III级),117例(14%)LVDD等级不确定。当 LA 应变的切点为 18%、24% 和 35% 时,受试者会相应地被重新分类为正常或依赖 LVDD。重新分类后的结果风险分级与现行指南相似:结论:LA 储库应变通过消除不确定状态/等级,改善了 LVDD 评估,同时保持了与现行指南相同的有效结果分层。
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来源期刊
Journal of Cardiac Failure
Journal of Cardiac Failure 医学-心血管系统
CiteScore
7.80
自引率
8.30%
发文量
653
审稿时长
21 days
期刊介绍: Journal of Cardiac Failure publishes original, peer-reviewed communications of scientific excellence and review articles on clinical research, basic human studies, animal studies, and bench research with potential clinical applications to heart failure - pathogenesis, etiology, epidemiology, pathophysiological mechanisms, assessment, prevention, and treatment.
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