Left atrial phasic echocardiographic functional analysis in relation to diastolic left ventricular hemodynamic parameters acquired during right heart catheterization

Abstract

Introduction: Doppler echocardiography has become the leading non-invasive tool for hemodynamic screening and follow-up in various clinical situations. Our objective was to assess whether left atrium (LA) functional echocardiographic parameters correlate with hemodynamic left ventricle (LV) filling parameters measured during right heart catheterization (RHC) in various disease states. Methods: Echocardiographic examinations of 71 consecutive patients that had RHC within 24 h were studied retrospectively using LA/LV feature tracking analysis. Echocardiographic and myocardial mechanics characteristics were then correlated with the RHC findings. Results: The best correlation were demonstrated between the trans-tricuspid gradient in the echocardiogram and the right ventricle (RV) systolic pressure in the RHC (R2 = 0.41, p < 0.0001). Mitral E/E’ annular velocity ratio did not correlate with capillary wedge pressure (CWP) while E velocity correlated significantly with CWP (R2 = 0.29, p = 0.0007). Among 38 patients in sinus rhythm, echocardiographic diastolic dysfunction strongly correlated with elevated LA pressure in RHC (CWP ≥ 12 mmHg, p = 0.001), with 96% sensitivity and 80% specificity. LA minimal volume index (LAVmin-i) as measured by echocardiogram was significantly correlated with elevated LA pressure in RHC (p = 0.04, criterion ≥ 27 ml) regardless of rhythm. Conclusions: In patients with sinus rhythm, diastolic dysfunction was found to be sensitive and specific for elevated CWP ≥ 12 mmHg at RHC. In all patients regardless of rhythm, LAVmin-i was found to correlate best with elevated LA pressure at RHC. This may suggest a new tool for assessment of diastolic dysfunction in all subjects.

Keywords

• Diastolic dysfunction
• Echocardiography
• Right heart catheterization
• RHC