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Comparison of Atrial Strain and Strain Rate and Volumes to Measure Phasic Atrial Function
S26
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
and intraconduit thrombus, fibroelastomas, prosthetic valve anatomy and visualization of periprosthetic defects, atrial masses and atrial septal geometry. The additional information provided by biplane and RT 3D imaging was useful in guiding intervention and clinical decision making. Conclusions: Biplane 2D and RT 3D TOE imaging provides significant additional useful clinical information in approximately 30% cases referred. doi:10.1016/j.hlc.2009.05.054 53 COMPARING TISSUE DOPPLER IMAGING WITH SPECKLE TRACKING IN ESTIMATING LEFT VENTRICULAR END DIASTOLIC PRESSURE K.K. Kadappu 1,2 , A.C. D.Y.C.
Leung 1,2 ,
1 Liverpool
L.
Boyd 1 , C.
Allman 1 , S.
Lo 1,2 ,
Thomas 1,2
Hospital, Liverpool, NSW 2173, Australia of New South Wales, Sydney, NSW, Australia
2 University
LV end diastolic pressure (LVEDP) is usually measured invasively. We sought to examine if colour tissue Doppler imaging (CDTI) is comparable with speckle tracking derived (ST) E/E velocity in estimating LVEDP. Methods: 60 patients (62 ± 12 years) undergoing angiography had an echocardiogram performed just prior. CDTI E velocities were measured from six annular segments from three apical views and ST E velocities were obtained from corresponding annular segments. Transmitral peak E velocity was measured. LVEDP was measured with a fluid-filled catheter in the LV. Results: E/E , measured by CDTI using either septal, lateral, average of 2, 4, 6 segments correlated significantly with LVEDP (p < 0.05 in all). However, E/E computed from E velocity from septal, lateral, average of 2, 4 or 6 segments derived by ST did not correlate with LVEDP. The lateral segment model for E/E by CDTI had the largest area under the ROC curves (0.69) in identifying LVEDP of ≥12 mmHg with a sensitivity of 84% and specificity of 52% for an E/E ratio >9. Average of septal and lateral segments and average of 6 annular segments for E/E velocity had AUCs of 0.67 and 0.66, respectively when E/E > 9 was used to identify patients with an LVEDP >12 mmHg, with comparable sensitivity but reduced specificity. Conclusion: Although CDTI and ST provide an offline option for estimation of E velocity, E velocity measurements by CDTI cannot be used interchangeably with ST derived E velocity for estimation of LVEDP. doi:10.1016/j.hlc.2009.05.055
54 COMPARISON OF ATRIAL STRAIN AND STRAIN RATE AND VOLUMES TO MEASURE PHASIC ATRIAL FUNCTION A.C. Boyd 1,2 , D.L. Ross 2 , D.Y. Leung 1 , L. Thomas 1,3 1 Univeristy
of NSW, Sydney, Australia Hospital, Sydney, Australia 3 Liverpool Hospital, Sydney, Australia 2 Westmead
Background: Left atrial (LA) volumes are surrogate markers of phasic atrial function. Strain (SI) and strain rate (SR) quantify intrinsic deformation of the atrial myocardium. The aim of this study was to compare phasic atrial volumes to strain parameters to evaluated phasic atrial function. Methods: Transthoracic echocardiograms were performed on 188 normal subjects. Biplane maximum, minimum and pre p LA volumes were measured indexed to BSA. Total LA, passive and active emptying volumes were calculated. SI and SR were measured from superior segments in the apical four and two chamber views of the LA, and global values calculated as the mean of the four segments. Peak systolic SI and S sr, early diastolic SI and E sr and late diastolic A sr were measured. Results: Subjects were aged 45 ± 15 years (range 21–80 years) and 43% were male. Systolic SI and S sr did not significantly correlate with total emptying volume. Diastolic SI and E sr had a significant positive correlation with passive emptying volume. Additionally A sr positively correlated with active emptying volume. Phase
Volumes
Function
r
Relaxation
Total LA Emp Vol (ml/m2 )
Systolic SI (%)
0.14
0.06
S sr (s−1 ) Diastolic SI (%)
0.17 0.21
0.14 0.01*
Passive contraction
Active contraction
Passive Emp Vol (ml/m2 )
E sr (s−1 ) Active Emp A sr (s−1 ) Vol (ml/m2 )
p value
0.29 <0.001** 0.16 0.03*
Conclusion: LA passive and active contractile phases had a positive association between function and volume measurements. However during LA relaxation, intrinsic myocardial function and volume did not correlate. This discrepancy may be due to the geometric assumptions made during volume analysis. SI and SR can be used to accurately quantitate intrinsic atrial phasic function. doi:10.1016/j.hlc.2009.05.056
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
and intraconduit thrombus, fibroelastomas, prosthetic valve anatomy and visualization of periprosthetic defects, atrial masses and atrial septal geometry. The additional information provided by biplane and RT 3D imaging was useful in guiding intervention and clinical decision making. Conclusions: Biplane 2D and RT 3D TOE imaging provides significant additional useful clinical information in approximately 30% cases referred. doi:10.1016/j.hlc.2009.05.054 53 COMPARING TISSUE DOPPLER IMAGING WITH SPECKLE TRACKING IN ESTIMATING LEFT VENTRICULAR END DIASTOLIC PRESSURE K.K. Kadappu 1,2 , A.C. D.Y.C.
Leung 1,2 ,
1 Liverpool
L.
Boyd 1 , C.
Allman 1 , S.
Lo 1,2 ,
Thomas 1,2
Hospital, Liverpool, NSW 2173, Australia of New South Wales, Sydney, NSW, Australia
2 University
LV end diastolic pressure (LVEDP) is usually measured invasively. We sought to examine if colour tissue Doppler imaging (CDTI) is comparable with speckle tracking derived (ST) E/E velocity in estimating LVEDP. Methods: 60 patients (62 ± 12 years) undergoing angiography had an echocardiogram performed just prior. CDTI E velocities were measured from six annular segments from three apical views and ST E velocities were obtained from corresponding annular segments. Transmitral peak E velocity was measured. LVEDP was measured with a fluid-filled catheter in the LV. Results: E/E , measured by CDTI using either septal, lateral, average of 2, 4, 6 segments correlated significantly with LVEDP (p < 0.05 in all). However, E/E computed from E velocity from septal, lateral, average of 2, 4 or 6 segments derived by ST did not correlate with LVEDP. The lateral segment model for E/E by CDTI had the largest area under the ROC curves (0.69) in identifying LVEDP of ≥12 mmHg with a sensitivity of 84% and specificity of 52% for an E/E ratio >9. Average of septal and lateral segments and average of 6 annular segments for E/E velocity had AUCs of 0.67 and 0.66, respectively when E/E > 9 was used to identify patients with an LVEDP >12 mmHg, with comparable sensitivity but reduced specificity. Conclusion: Although CDTI and ST provide an offline option for estimation of E velocity, E velocity measurements by CDTI cannot be used interchangeably with ST derived E velocity for estimation of LVEDP. doi:10.1016/j.hlc.2009.05.055
54 COMPARISON OF ATRIAL STRAIN AND STRAIN RATE AND VOLUMES TO MEASURE PHASIC ATRIAL FUNCTION A.C. Boyd 1,2 , D.L. Ross 2 , D.Y. Leung 1 , L. Thomas 1,3 1 Univeristy
of NSW, Sydney, Australia Hospital, Sydney, Australia 3 Liverpool Hospital, Sydney, Australia 2 Westmead
Background: Left atrial (LA) volumes are surrogate markers of phasic atrial function. Strain (SI) and strain rate (SR) quantify intrinsic deformation of the atrial myocardium. The aim of this study was to compare phasic atrial volumes to strain parameters to evaluated phasic atrial function. Methods: Transthoracic echocardiograms were performed on 188 normal subjects. Biplane maximum, minimum and pre p LA volumes were measured indexed to BSA. Total LA, passive and active emptying volumes were calculated. SI and SR were measured from superior segments in the apical four and two chamber views of the LA, and global values calculated as the mean of the four segments. Peak systolic SI and S sr, early diastolic SI and E sr and late diastolic A sr were measured. Results: Subjects were aged 45 ± 15 years (range 21–80 years) and 43% were male. Systolic SI and S sr did not significantly correlate with total emptying volume. Diastolic SI and E sr had a significant positive correlation with passive emptying volume. Additionally A sr positively correlated with active emptying volume. Phase
Volumes
Function
r
Relaxation
Total LA Emp Vol (ml/m2 )
Systolic SI (%)
0.14
0.06
S sr (s−1 ) Diastolic SI (%)
0.17 0.21
0.14 0.01*
Passive contraction
Active contraction
Passive Emp Vol (ml/m2 )
E sr (s−1 ) Active Emp A sr (s−1 ) Vol (ml/m2 )
p value
0.29 <0.001** 0.16 0.03*
Conclusion: LA passive and active contractile phases had a positive association between function and volume measurements. However during LA relaxation, intrinsic myocardial function and volume did not correlate. This discrepancy may be due to the geometric assumptions made during volume analysis. SI and SR can be used to accurately quantitate intrinsic atrial phasic function. doi:10.1016/j.hlc.2009.05.056