Integrating Left Atrial Reservoir Strain Into the First-Line Assessment of Diastolic Function: Prognostic Implications in a Community-Based Cohort With Normal Left Ventricular Systolic Function.

IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Máté Tolvaj, Fjolla Zhubi Bakija, Alexandra Fábián, Andrea Ferencz, Bálint Lakatos, Zsuzsanna Ladányi, Ádám Szijártó, Borbála Edvi, Loretta Kiss, Zsolt Szelid, Pál Soós, Béla Merkely, Zsolt Bagyura, Márton Tokodi, Attila Kovács
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引用次数: 0

Abstract

Background: Left atrial (LA) reservoir strain (LASr) has emerged as a sensitive marker of LA function and elevated filling pressures, even though its role in detecting diastolic dysfunction (DD) and the subsequent risk stratification has remained relatively underexplored. Accordingly, we aimed to investigate the prognostic implications of replacing LA volume index (LAVi) with LASr in the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) algorithm for diagnosing DD, compared to the 2024 British Society of Echocardiography (BSE) algorithm, in individuals with normal left ventricular (LV) systolic function.

Methods: We retrospectively identified 1,180 volunteers from a population-based screening program with normal LV systolic function and no evidence of myocardial disease. Echocardiographic measurements comprised recommended parameters of diastolic function and LASr by speckle-tracking. Diastolic function was assessed using the BSE algorithm and the modified ASE/EACVI algorithm, in which LAVi >34 mL/m2 was replaced with LASr <23%. The primary endpoint was the composite of all-cause mortality and heart failure hospitalization.

Results: During a median follow-up of 11 years, 133 (11%) individuals met the primary endpoint. Using the BSE algorithm, there was no difference in the risk of meeting the primary endpoint between individuals with normal diastolic function and those with impaired diastolic function with normal filling pressures. In univariable analysis, individuals having impaired diastolic function with elevated filling pressures exhibited a significantly higher risk than those in the other 2 groups (unadjusted hazard ratios = 4.408 [95% CI, 2.376-8.179], P < .001; and 5.137 [95% CI, 1.138-23.181], P = .033, respectively). However, these differences were no longer significant after adjusting for relevant covariates. In contrast, the modified ASE/EACVI algorithm identified 3 groups with distinct risk profiles, and even in multivariable analysis, individuals with DD had a higher risk of meeting the primary endpoint than those with normal diastolic function (adjusted hazard ratio = 3.199 [95% CI, 1.534-6.671], P = .002).

Conclusion: In a community-based cohort with normal LV function, integrating LASr into the first-line echocardiographic assessment of diastolic function improved both classification and subsequent risk stratification.

将左心房贮器应变纳入舒张功能的一线评估:在左心室收缩功能正常的社区队列中的预后意义。
背景:左心房储层应变(LASr)已成为左心房功能和充盈压力升高的敏感标志物,尽管其在检测舒张功能障碍(DD)和随后的风险分层中的作用仍未得到相对充分的研究。因此,我们旨在研究在2016年ASE/EACVI算法中用LASr代替左心房容积指数(LAVi)诊断DD的预后意义,与2024年BSE算法相比,在左室(LV)收缩功能正常的个体中。方法:我们从以人群为基础的筛查项目中回顾性地确定了1180名左室收缩功能正常且无心肌疾病证据的志愿者。超声心动图测量包括推荐的舒张功能参数和散斑跟踪LASr。使用BSE算法和改进的ASE/EACVI算法评估舒张功能,其中LASr取代LAVi >34 ml/m2结果:在中位随访11年期间,133例(11%)个体达到主要终点。使用BSE算法,舒张功能正常的个体和充盈压力正常的舒张功能受损的个体达到主要终点的风险没有差异。在单变量分析中,舒张功能受损且充血压力升高的个体的风险明显高于其他两组(未经调整的hr: 4.408 [95% CI: 2.376 - 8.179])。结论:在一个以社区为基础的左室功能正常的队列中,将LASr纳入一线超声心动图舒张功能评估可以改善分类和随后的风险分层。
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来源期刊
CiteScore
9.50
自引率
12.30%
发文量
257
审稿时长
66 days
期刊介绍: The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.
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