The additive value of echocardiographic pulmonary to left atrial global strain ratio in the diagnosis of pulmonary hypertension. (1st October 2019)

• Record Type: Journal Article
• Authors: Venkateshvaran, Ashwin; Manouras, Aristomenis; Kjellström, Barbro; Lund, Lars H.
• Is Part Of: International journal of cardiology. Volume 292(2019)
• Page Start: 205
• Page End: 210
• Publication Date: 2019-10-01
• Subjects: Left atrial strain -- Pulmonary vascular resistance -- Pre-capillary pulmonary hypertension -- Post-capillary pulmonary hypertension -- Heart failure; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.05.025
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The distinction between pre-capillary and post-capillary pulmonary hypertension (PH) is central to accurate diagnosis and appropriate therapy. We aimed to investigate the ability of the novel echocardiographic pulmonary to left atrial global strain ratio (ePLAGS) to distinguish pre-capillary from post-capillary PH and compare its discriminatory strength with the echocardiographic pulmonary to left atrial ratio (ePLAR). Methods: Consecutive subjects with unexplained dyspnea or heart failure underwent echocardiography immediately followed by right heart catheterization. Subjects who did not satisfy the ESC/ERS criteria for PH, in atrial fibrillation or under pacemaker therapy, or with significant concomitant valvular disease were excluded. ePLAGS was calculated as peak tricuspid regurgitation velocity divided by left atrial global reservoir strain. Results: One hundred and thirty PH subjects, as defined by right heart catheterization, were included in the analysis (pre-capillary: n = 64, post-capillary: n = 66). ePLAGS was lower in pre-capillary compared with post-capillary PH (0.19 ± 0.14 vs. 0.45 ± 0.58 m/s/%; p = 0.02) and significantly different between combined post- and pre-capillary PH (Cpc-PH) and isolated post-capillary PH (Ipc-PH) (0.62 ± 0.85 vs. 0.32 ± 0.19 m/s/%; p = 0.04). ePLAR was higher in pre-capillary as compared with post-capillary PH (0.37 ± 0.16 vs. 0.20 ± 0.08; p < 0.001) but did not differ between Ipc-PH and Cpc-PH. ePLAGS demonstrated stronger discriminating power than ePLAR to distinguish pre-capillary from post-capillary PH (AUC = 0.80 vs. 0.70). In the setting of post capillary PH, ePLAGS showed reasonable ability to distinguish Ipc-PH from Cpc-PH (AUC = 0.65). ePLAR, however, did not differentiate these two groups (AUC = 0.49; p > 0.05). Conclusions: ePLAGS accurately differentiates pre-capillary from post-capillary PH and demonstrates higher diagnostic ability than ePLAR. Highlights: Non-invasive ePLAGS is associated with invasive pulmonary vascular resistance. The novel ratio differentiates pre- from post-capillary PH, and Ipc-PH from Cpc-PH. ePLAGS demonstrates superior diagnostic performance vs. ePLAR.