Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2022; 19 (4): 287-392 ➤ Параметры деформации миокарда левого предсердия как маркер диастолической дисфункции у больных ишемической болезнью сердца

Parameters of deformation of the left atrium as a marker of diastolic dysfunction in patients with ischemic heart disease

Authors: Koksheneva I.V., Kaplenko L.I., Turakhonov T.K., Iraskhanov A.Sh.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2022-19-4-326-337

UDC: 616.127-005.8:616.12-005.4

Link: Clinical Physiology of Blood Circulaiton. 2022; 4 (19): 326-337

Quote as: Koksheneva I.V., Kaplenko L.I., Turakhonov T.K., Iraskhanov A.Sh. Parameters of deformation of the left atrium as a marker of diastolic dysfunction in patients with ischemic heart disease. Clinical Physiology of Circulation. 2022; 19 (4): 326–37 (in Russ.). DOI: 10.24022/1814-6910-2022-19-4-326-337

Keywords:  dysfunction and remodeling of the left atrium diastolic dysfunction strain and strain rate of the left atrial Strain and Strain Rate of the left ventricular

Received / Accepted:  12.11.2022 / 09.12.2022

Full text:  

Abstract

The aim of the study was to evaluate the relationship between the severity of LV diastolic dysfunction and LA function according to the analysis of Strain parameters and Strain Rate of the myocardium in patients with IHD.

Material and methods. The study included 80 patients with stable coronary heart disease, with preserved or moderately reduced LV contractility (LV EF ≥ 45%). Three groups were formed: group 1 (16 patients) – patients with coronary artery disease with normal LV diastolic function; group 2 (49 patients) – patients with coronary artery disease with I degree of LV DD (impaired relaxation); group 3 (15 patients) – patients with coronary artery disease with II degree of LV DD (pseudonormal filling). There were no patients with grade III LV DD (restrictive filling) in the study. All patients underwent a study of longitudinal global Strain and Strain Rate of the LA myocardium (in the reservoir, conduit, and contraction phases) and LV.

Results. It has been established that as the diastolic dysfunction worsens, there is a decrease in the Strain and Strain Rate parameters of the LA during all phases of its mechanical function – reservoir, conduit and active contraction. The stiffness of the left atrial myocardium also increases as LV diastolic dysfunction worsens. At the same time, the parameters of structural remodeling of the LA (linear dimensions and indexed volume of the LA) did not differ significantly in patients with varying degrees of LV DD. Correlation relationships of Strain and Strain Rate of LA in the reservoir phase (LASr) with indicators of LV diastolic function (e', E/e') and in the contraction phase (LASct) with рulmonary capillary wedge pressure were established.

Conclusion. LA Strain is a marker of LA dysfunction that occurs with the progression of DD. The study of LA Strain can be a useful additional tool for assessing diastolic dysfunction in clinical practice.

References

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****
  1. Nishimura R.A., Borlaug B.A. Diastology for the clinician. J. Cardiol. 2019; 73 (6): 445–52. DOI: 10.1016/j.jjcc.2019.03.002
  2. Bianco C.M., Farjo P.D., Ghaffar Y.A., Sengupta P.P. Myocardial mechanics in patients with normal LVEF and diastolic dysfunction. JACC. Cardiovasc. Imaging. 2020; 13 (1 Pt 2): 258–71. DOI: 10.1016/j.jcmg.2018.12.035
  3. Samiei N., Abbasi F., Shojaeifard M., Parsaee M., Hosseini S., Rezaei Y., Naderi N. Affiliations expand the role of left atrial strain in detecting left ventricular diastolic dysfunction: comparison between the 2009 and 2016 recommendations. J. Tehran. Heart Cent. 2021; 16 (2): 58–67. DOI: 10.18502/jthc.v16i2.7386
  4. Cameli M., Mandoli G.E., Loiacono F., Dini F.L., Henein M., Mondillo S. Left atrial strain: a new parameter for assessment of left ventricular filling pressure. Heart Fail. Rev. 2016; 21 (1): 65–76. DOI: 10.1007/s10741-015-9520-9
  5. Thomas L., Marwick T.H., Popescu B.A., Donal E., Badano L.P. Left atrial structure and function, and left ventricular diastolic dysfunction: JACC state-of-the-art review. J. Am. Coll. Cardiol. 2019; 73 (15): 1961–77. DOI: 10.1016/j.jacc.2019.01.059
  6. Cho G.Y., Hwang I.C. Left atrial strain measurement: a new normal for diastolic assessment? JACC. Cardiovasc. Imaging. 2020; 13 (11): 2327–9. DOI: 10.1016/j.jcmg. 2020.05.014
  7. Nagueh S.F., Smiseth O.A., Appleton C.P., Byrd B.F., Dokainish H., Edvardsen T. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2016; 29 (4): 277–314. DOI: 10.1016/j.echo.2016.01.011
  8. Morris D.A., Takeuchi M., Krisper M., Köhncke C., Bekfani T., Carstensen T. et al. Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur. Heart J. Cardiovasc. Imaging. 2015; 16 (4): 364–72. DOI: 10.1093/ehjci/jeu219
  9. Pezel Т., Ambale Venkatesh В., Doria De Vasconcellos Н., Kato Y., Shabani M., Xie E. et al. Left atrioventricular coupling index as a prognostic marker of cardiovascular events: the MESA study. Hypertension. 2021; 78: 661–71. DOI: 10.1161/HYPERTENSIONAHA.121.17339
  10. Xu B., Liu L., Abdu F.A., Yin G., Mohammed A.Q., Xu S. et al. Prognostic value of diastolic dysfunction derived from D-SPECT in coronary artery disease patients with normal ejection fraction. Front. Cardiovasc. Med. 2021; 8: 700027. DOI: 10.3389/fcvm.2021.700027
  11. Farjana J., Rahman M.A., Rahman M.M., Khalequzzaman M., Hussain K.S., Firoz M.U. et al. Association of diastolic dysfunction with angiographic severity of coronary artery disease in patients with Non-ST elevation myocardial infarction. Mymensingh. Med. J. 2022; 31 (3): 773–8.
  12. Суханов С.Г., Орехова Е.Н., Матановская Т.В. Оценка механической функции левого предсердия у пациентов с ишемической митральной регургитацией. Патология кровообращения и кардиохирургия. 2015; 19 (2): 55–62. Sukhanov S.G., Orekhova E.N., Matanovskaya T.V. Assessment of the mechanical function of the left atrium in patients with ischemic mitral regurgitation. Circulatory pathology and cardiac surgery. 2015; 19 (2): 55–62 (in Russ.).
  13. Бузиашвили Ю.И., Кокшенева И.В., Асымбекова Э.У., Турахонов Т.К. Функциональное состояние левого предсердия у больных с ИБС и различными типами ишемической митральной регургитации по данным тканевой допплерографии. Кардиология и сердечно-сосудистая хирургия. 2019; 12 (1): 9–16.
  14. Bisbal F., Baranchuk A., Braunwald E., Bayés de Luna A., Bayés-Genís A. Atrial failure as a clinical entity: JACC review topic of the week. J. Am. Coll. Cardiol. 2020; 75 (2): 222–32. DOI: 10.1016/j.jacc.2019.11.013
  15. Potter E.L., Ramkumar S., Kawakami H., Yang H., Wright L., Negishi T., Marwick T.H. Association of asymptomatic diastolic dysfunction assessed by left atrial strain with incident heart failure. JACC. Cardiovasc. Imaging. 2020; 13 (11): 2316–26. DOI: 10.1016/j.jcmg.2020.04.028
  16. Singh A., Addetia K., Maffessanti F., Mor-Avi V., Lang R.M. LA Strain for categorization of LV diastolic dysfunction. JACC. Cardiovasc. Imaging. 2017; 10 (7): 735–43. DOI: 10.1016/j.jcmg.2016.08.014
  17. Melenovsky V., Hwang S.J., Redfield M.M., Zakeri R., Lin G., Borlaug B.A. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ. Heart Fail. 2015; 8 (2): 295–303. DOI: 10.1161/CIRCHEARTFAILURE.114.001667
  18. Bytyçi I., D'Agostino A., Bajraktari G., Lindqvist P., Dini F.L., Henein M.Y. Left atrial stiffness predicts cardiac events in patients with heart failure and reduced ejection fraction: The impact of diabetes. Clin. Physiol. Funct. Imaging. 2021; 41 (2): 208–16. DOI: 10.1111/cpf.12688
  19. Zhu S., Lin Y., Zhang Y., Wang G., Qian M., Gao L. et al. Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus. Front. Cardiovasc. Med. 2022; 9: 947639. DOI: 10.3389/fcvm.2022.947639
  20. Jarasunas J., Aidietis A., Aidietiene S. Left atrial strain – an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation. Cardiovasc. Ultrasound. 2018; 16 (1): 29. DOI: 10.1186/s12947-018-0147-6
  21. Kraigher-Krainer E., Shah A.M., Gupta D.K., Santos A., Claggett B., Pieske B. et al. PARAMOUNT Investigators. Impaired systolic function by strain imaging in heart failure with preserved ejection fraction. J. Am. Coll. Cardiol. 2014; 63 (5): 447–56. DOI: 10.1016/j.jacc.2013.09.052
  22. Inoue K., Khan F.H., Remme E.W., Ohte N., GarcíaIzquierdo E., Chetrit M. et al. Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure. Eur. Heart J. Cardiovasc. Imaging. 2021; 23 (1): 61–70. DOI: 10.1093/ehjci/jeaa415
****
  1. Nishimura R.A., Borlaug B.A. Diastology for the clinician. J. Cardiol. 2019; 73 (6): 445–52. DOI: 10.1016/j.jjcc.2019.03.002
  2. Bianco C.M., Farjo P.D., Ghaffar Y.A., Sengupta P.P. Myocardial mechanics in patients with normal LVEF and diastolic dysfunction. JACC. Cardiovasc. Imaging. 2020; 13 (1 Pt 2): 258–71. DOI: 10.1016/j.jcmg.2018.12.035
  3. Samiei N., Abbasi F., Shojaeifard M., Parsaee M., Hosseini S., Rezaei Y., Naderi N. Affiliations expand the role of left atrial strain in detecting left ventricular diastolic dysfunction: comparison between the 2009 and 2016 recommendations. J. Tehran. Heart Cent. 2021; 16 (2): 58–67. DOI: 10.18502/jthc.v16i2.7386
  4. Cameli M., Mandoli G.E., Loiacono F., Dini F.L., Henein M., Mondillo S. Left atrial strain: a new parameter for assessment of left ventricular filling pressure. Heart Fail. Rev. 2016; 21 (1): 65–76. DOI: 10.1007/s10741-015-9520-9
  5. Thomas L., Marwick T.H., Popescu B.A., Donal E., Badano L.P. Left atrial structure and function, and left ventricular diastolic dysfunction: JACC state-of-the-art review. J. Am. Coll. Cardiol. 2019; 73 (15): 1961–77. DOI: 10.1016/j.jacc.2019.01.059
  6. Cho G.Y., Hwang I.C. Left atrial strain measurement: a new normal for diastolic assessment? JACC. Cardiovasc. Imaging. 2020; 13 (11): 2327–9. DOI: 10.1016/j.jcmg. 2020.05.014
  7. Nagueh S.F., Smiseth O.A., Appleton C.P., Byrd B.F., Dokainish H., Edvardsen T. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2016; 29 (4): 277–314. DOI: 10.1016/j.echo.2016.01.011
  8. Morris D.A., Takeuchi M., Krisper M., Köhncke C., Bekfani T., Carstensen T. et al. Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur. Heart J. Cardiovasc. Imaging. 2015; 16 (4): 364–72. DOI: 10.1093/ehjci/jeu219
  9. Pezel Т., Ambale Venkatesh В., Doria De Vasconcellos Н., Kato Y., Shabani M., Xie E. et al. Left atrioventricular coupling index as a prognostic marker of cardiovascular events: the MESA study. Hypertension. 2021; 78: 661–71. DOI: 10.1161/HYPERTENSIONAHA.121.17339
  10. Xu B., Liu L., Abdu F.A., Yin G., Mohammed A.Q., Xu S. et al. Prognostic value of diastolic dysfunction derived from D-SPECT in coronary artery disease patients with normal ejection fraction. Front. Cardiovasc. Med. 2021; 8: 700027. DOI: 10.3389/fcvm.2021.700027
  11. Farjana J., Rahman M.A., Rahman M.M., Khalequzzaman M., Hussain K.S., Firoz M.U. et al. Association of diastolic dysfunction with angiographic severity of coronary artery disease in patients with Non-ST elevation myocardial infarction. Mymensingh. Med. J. 2022; 31 (3): 773–8.
  12. Sukhanov S.G., Orekhova E.N., Matanovskaya T.V. Assessment of the mechanical function of the left atrium in patients with ischemic mitral regurgitation. Circulatory pathology and cardiac surgery. 2015; 19 (2): 55–62 (in Russ.).
  13. Buziashvili Yu.I., Koksheneva I.V., Asymbekova E.U., Turakhonov T.K. Functional state of the left atrium in patients with ischemic heart disease and various types of ischemic mitral regurgitation according to tissue dopplerography. Cardiology and cardiovascular surgery. 2019; 12 (1): 9–16 (in Russ.).
  14. Bisbal F., Baranchuk A., Braunwald E., Bayés de Luna A., Bayés-Genís A. Atrial failure as a clinical entity: JACC review topic of the week. J. Am. Coll. Cardiol. 2020; 75 (2): 222–32. DOI: 10.1016/j.jacc.2019.11.013
  15. Potter E.L., Ramkumar S., Kawakami H., Yang H., Wright L., Negishi T., Marwick T.H. Association of asymptomatic diastolic dysfunction assessed by left atrial strain with incident heart failure. JACC. Cardiovasc. Imaging. 2020; 13 (11): 2316–26. DOI: 10.1016/j.jcmg.2020.04.028
  16. Singh A., Addetia K., Maffessanti F., Mor-Avi V., Lang R.M. LA Strain for categorization of LV diastolic dysfunction. JACC. Cardiovasc. Imaging. 2017; 10 (7): 735–43. DOI: 10.1016/j.jcmg.2016.08.014
  17. Melenovsky V., Hwang S.J., Redfield M.M., Zakeri R., Lin G., Borlaug B.A. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ. Heart Fail. 2015; 8 (2): 295–303. DOI: 10.1161/CIRCHEARTFAILURE.114.001667
  18. Bytyçi I., D'Agostino A., Bajraktari G., Lindqvist P., Dini F.L., Henein M.Y. Left atrial stiffness predicts cardiac events in patients with heart failure and reduced ejection fraction: The impact of diabetes. Clin. Physiol. Funct. Imaging. 2021; 41 (2): 208–16. DOI: 10.1111/cpf.12688
  19. Zhu S., Lin Y., Zhang Y., Wang G., Qian M., Gao L. et al. Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus. Front. Cardiovasc. Med. 2022; 9: 947639. DOI: 10.3389/fcvm.2022.947639
  20. Jarasunas J., Aidietis A., Aidietiene S. Left atrial strain – an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation. Cardiovasc. Ultrasound. 2018; 16 (1): 29. DOI: 10.1186/s12947-018-0147-6
  21. Kraigher-Krainer E., Shah A.M., Gupta D.K., Santos A., Claggett B., Pieske B. et al. PARAMOUNT Investigators. Impaired systolic function by strain imaging in heart failure with preserved ejection fraction. J. Am. Coll. Cardiol. 2014; 63 (5): 447–56. DOI: 10.1016/j.jacc.2013.09.052
  22. Inoue K., Khan F.H., Remme E.W., Ohte N., GarcíaIzquierdo E., Chetrit M. et al. Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure. Eur. Heart J. Cardiovasc. Imaging. 2021; 23 (1): 61–70. DOI: 10.1093/ehjci/jeaa415

About Authors

  • Inna V. Koksheneva, Dr. Med. Sci., Senior Researcher; ORCID
  • Lidiya I. Kaplenko, Postgraduate; ORCID
  • Timur K. Turakhonov, Cand. Med. Sci., Cardiologist; ORCID
  • Atabi Sh. Iraskhanov, Applicant; ORCID

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