Combined atrioventricular longitudinal strain rate during isovolumic contraction predicts pulmonary capillary wedge pressure in patients with systolic dysfunction

Alaa Mabrouk Salem Omar; Diana Maria Ronderos Botero; Javier Arreaza Caraballo; Ga Hee Kim; Yeraz Khachatoorian; Pranav Sharma; Jonathan N Bella; Johanna Contreras; Osama Rifaie; Mohamed A Abdel-Rahman

Combined atrioventricular longitudinal strain rate during isovolumic contraction predicts pulmonary capillary wedge pressure in patients with systolic dysfunction

Am J Cardiovasc Dis. 2021 Aug 15;11(4):530-538. eCollection 2021.

Authors

Affiliations

¹ Department of Cardiovascular Medicine, Mount Sinai Morningside New York, NY, USA.
² Department of Medicine, BronxCare Hospital Center Bronx, NY, USA.
³ Department of Cardiovascular Medicine, BronxCare Hospital Center Bronx, NY, USA.
⁴ Department of Cardiovascular Medicine, Ain Shams University Hospital Cairo, Egypt.

PMID: 34548952
PMCID: PMC8449199

Abstract

Background: Reportedly, mitral annular velocities derived by tissue Doppler imaging (TDI)-during isovolumic contraction (IVV) can predict pulmonary capillary wedge pressure (PCWP) in heart failure patients with depressed ejection fraction (EF). We investigated the use of color TDI-derived left atrial (LA) and left ventricular (LV) longitudinal strain rate (SR) during isovolumic contraction (IC) to predict the invasively measured PCWP.

Methods and results: Forty patients referred with symptoms of heart failure were prospectively studied [age: 56±8 years, 12 (30%) females, and mean LVEF: 51±14%]. PCWP was measured invasively immediately after echocardiography. Mitral annular IVV was measured for all patients and SR during the IC and ejection were measured for the LV (LVSR-IC, LVSR-Ej) as well as the LA (LASR-IC, and LASR-Ej). Atrioventricular SR during IC and Ej (AVSR-IC, AVSR-Ej) was calculated as the sum of the LV and LA values. Patients were classified and compared based on their EF into 19 (49%) with EF≥55%, and 21 (51%) with EF<55%. No significant differences were noted for age, sex, risk factors, and medications between both patients with EF≥55% and EF<55%. Compared to EF≥55%, patients with EF<55% had lower IVV (4.63±1.2 vs. 7.01±1.9 cm/s, P<0.001), LVSR-Ej (1±0.3 vs. 1.2±0.2, P=0.03), LASR-IC (1.3±0.6 vs. 1.9±1, P=0.03), LASR-Ej (1.5±0.5 vs. 2.6±1.3 s^-1, P=0.001), AVSR-IC (2±0.8 vs. 2.7±1.06 s^-1, P=0.023), and AVSR-Ej (2.5±0.6 vs. 3.9±1.1 s^-1, <0.001). LVSR-IC, LVSR-Ej, LASR-IC, AVSR-IC, and IVV correlated with PCWP in only in EF<55%, with the strongest correlation noted for AVSR-IC (r=-0.72, <0.001). Other correlates with PCWP in EF<55% were E/e' and left atrial volume (r=0.47, 0.7, P=0.04, 0.001; respectively). Multivariate regression revealed that in patients with EF<55% AVSR-IC was the only independent predictor of PCWP. Finally, IVV correlated with LVSR-IC and LASR-IC and this correlation became strongest with AVSR-IC (r=0.77, 0.001).

Conclusion: The combined LV and LA longitudinal SR during IC as represented by AVSR-IC showed a strong correlation with PCWP in patients with depressed EF. The correlation between mitral annular IVV and PCWP in those patients can be a product of this combination and may a function of atrioventricular mechanical coupling.

Keywords: Isovolumic contraction; heart failure; longitudinal strain rate; pulmonary capillary wedge pressure.