Journal of Clinical Trials
Open Access

Abstract

Accuracy of Left Atrial Strain in Predicting Left Ventricular End Diastolic Pressure: Comparative Study Tissue Doppler Imaging and Invasive Assessment

Saud M Elsaughier, Ramadan Ghaleb, Mohamed K Slama and Mohamed A Saleh

Background: The ratio of the early transmitral inflow velocity to the mitral annular early-diastolic myocardial velocity (E/Em ratio) determined by tissue Doppler imaging (TDI) has been increasingly applied as a non-invasive method for evaluating the left ventricular filling pressure (LVFP). This study aimed to assess the performance of TDI parameters and the left atrial global longitudinal strain as non-invasive surrogates for the LVFP and to compare the accuracy of these two parameters across different striae of LVEF.

Methods: The study included 96 patients with a sinus rhythm, various EFs and an invasive recording of the LV pressure; these patients were split into four groups of 24 patients each according to their EF (>55%, 45–54%, 30–44%, and<30%). Both the medial and lateral E/Em ratios were quantified for all participants by 2D TDI; the peak atrial contraction strain (PACS) and peak atrial longitudinal strain (PALS) were obtained.

Results: There was a substantial correlation in terms of the global PALS and invasive LV end-diastolic pressure (LVEDP) in all groups (r=0.70, P<0.0.00), while the lateral E/E’, showed a significant correlation in only two groups: preserved and mildly impaired EF(r=0.42, P=0.023; r=0.439,P=0.32; respectively).

Conclusion: Patients with a somewhat impaired or preserved LVEF, the lateral E/E’ ratio and global PALS showed a fair correlation with the LVEDP. For patients with a moderate or extreme impairment, the E/E’ ratio showed a poor correlation with the invasively determined LVFP. The global PALS demonstrated the most suitable estimation of the LVFP.