TY - JOUR
T1 - Estimation of Mean Left Atrial Pressure in Patients with Acute Coronary Syndromes
T2 - A Doppler Echocardiographic and Cardiac Catheterization Study
AU - Tachjian, Ara
AU - Sanghai, Saket R.
AU - Stencel, Jason
AU - Parker, Matthew W.
AU - Kakouros, Nikolaos
AU - Aurigemma, Gerard P.
N1 - Publisher Copyright:
© 2018 American Society of Echocardiography
PY - 2019/3
Y1 - 2019/3
N2 - Background: Doppler echocardiography, including the ratio of transmitral E to tissue Doppler e′ velocities (E/e′), is widely used to estimate mean left atrial pressure (mLAP). This method, however, has not been validated in patients with acute coronary syndromes. Methods: Fifty-seven patients with acute coronary syndromes who underwent left heart catheterization and transthoracic echocardiography within 8 hours of each other were retrospectively analyzed. Forty-two of the patients (74%) were men, with a mean age of 65 ± 11 years. Patients with known cardiomyopathy, atrial fibrillation, or left-sided valvular disease were excluded. Doppler mLAP was estimated using Nagueh's formula (1.24 × [E/e′] + 1.9). Invasive mLAP was estimated using the formula of Yamamoto et al. (1.20 × mean left ventricular diastolic pressure – 0.82), wherein we averaged left ventricular diastolic pressure starting from the isovolumic relaxation phase to the post-A inflection point. Subanalyses were performed in groups with reduced or normal left ventricular ejection fraction (EF). Results: There was stronger agreement between the two techniques to estimate mLAP in the reduced EF group (r = 0.73, r 2 = 0.53, P < .001) compared with the normal EF group (r = 0.33, r 2 = 0.11, P = .08). The κ statistic for agreement was 0.34 for the overall study cohort, suggesting fair agreement according to partition values of mean mLAP: <8, 8 to 15, and >15 mm Hg. Left atrial volume index did not correlate with invasively estimated mLAP in this cohort. Conclusions: In patients with acute coronary syndromes, Doppler- and catheter-derived estimates of mLAP correlate well in patients with reduced EFs. In the acute setting, echocardiographic evaluation is a reliable adjunct to clinical examination in assessment of heart failure in this subgroup of patients.
AB - Background: Doppler echocardiography, including the ratio of transmitral E to tissue Doppler e′ velocities (E/e′), is widely used to estimate mean left atrial pressure (mLAP). This method, however, has not been validated in patients with acute coronary syndromes. Methods: Fifty-seven patients with acute coronary syndromes who underwent left heart catheterization and transthoracic echocardiography within 8 hours of each other were retrospectively analyzed. Forty-two of the patients (74%) were men, with a mean age of 65 ± 11 years. Patients with known cardiomyopathy, atrial fibrillation, or left-sided valvular disease were excluded. Doppler mLAP was estimated using Nagueh's formula (1.24 × [E/e′] + 1.9). Invasive mLAP was estimated using the formula of Yamamoto et al. (1.20 × mean left ventricular diastolic pressure – 0.82), wherein we averaged left ventricular diastolic pressure starting from the isovolumic relaxation phase to the post-A inflection point. Subanalyses were performed in groups with reduced or normal left ventricular ejection fraction (EF). Results: There was stronger agreement between the two techniques to estimate mLAP in the reduced EF group (r = 0.73, r 2 = 0.53, P < .001) compared with the normal EF group (r = 0.33, r 2 = 0.11, P = .08). The κ statistic for agreement was 0.34 for the overall study cohort, suggesting fair agreement according to partition values of mean mLAP: <8, 8 to 15, and >15 mm Hg. Left atrial volume index did not correlate with invasively estimated mLAP in this cohort. Conclusions: In patients with acute coronary syndromes, Doppler- and catheter-derived estimates of mLAP correlate well in patients with reduced EFs. In the acute setting, echocardiographic evaluation is a reliable adjunct to clinical examination in assessment of heart failure in this subgroup of patients.
KW - Acute coronary syndrome
KW - Doppler echocardiography
KW - Left ventricular end-diastolic pressure, LVEDP
KW - Left ventricular filling pressure
KW - Mean left atrial pressure, mLAP
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U2 - 10.1016/j.echo.2018.11.002
DO - 10.1016/j.echo.2018.11.002
M3 - Article
C2 - 30660349
AN - SCOPUS:85059934381
SN - 0894-7317
VL - 32
SP - 365-374.e1
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 3
ER -