Chapter 3. CAD & heart failure
Chapter 3. CAD & heart failure
LA Strain, RA Strain & diastolic dysfunction
LASr of 31,2% in AFIB & 35,1% in SR as cut-off for hospitalisation & lethal cardiac events in HFpEF
LA Strain better as LAVI in the detection of DD, LASr inversely correlates to NT-proBNP in HF
LASr <15,4% = PCWP >15mmHg (sensitivity 85%, specificity 82%) & differentiation pre- & postcapillary PHT (LASr 25% pre- & 10% postcapillary)
LA Strain as a marker for reverse remodeling (in HF, AFIB, MR, HOCMP etc.)
RA strain correlates with RA filling pressures in HFrEF with EF ≤35% (cut-off 20% RASr (DD grade I around 20%, DD II around 10%; <10% DD grade III, elevated RV filling pressures likely)
LASr <24,27% as cut-off for elevated filling pressures in patients with HTN (sensitivity 78,9%; specificity 84,6%)
Boe et al., EHC, CV Imaging, 2022; Carpenito et al., 2022 Frontiers in CV medicine; Inoue et al., Eur Heart J 2019 / Vakilian et al, J Cardiovasc Imaging, 2022; Jia et al, Frontiers in CV Medicine 2022;; Benfari The International Journal of CV Imaging 2022
LA Strain — AFIB & more
LASr ≤19% & LASct ≥-8,7% ➜ Patients in SR with HTN & paroxysmal AFIB
LASct <-3,4% as a marker of persisting SR at day 1 after cardioversion (4-ChV); LASr >14,6% as a marker of good prognosis & no relapse episode of AFIB at day 1 after CV
LASr ≤10% as a marker of AFIB relapse 6 months after CV (long-standing AFIB) ➜ sensitivity 85% & specificity 99%)
LASr ≤11% as an independent marker for LA thrombus formation (sensitivity 74% & specificity 65%)
LASr <11,1% = restrictive filling; <16% very likely elevated filling pressures
LASr <18% 5a onset AFIB in HF (all subgroups); correlation of LA fibrosis with LA Strain
LASr >35% ➜ normal diastolic function, LASr ≤19% as marker of DDIII (95% accuracy)
STEMI patients (48h after CAG) with LASr >28,9% ➜ rarely adverse LV-remodelling (6 months follow-up)
LASr reduced, LASct significantly reduced in a "weak atrium" 1 day after CV
Boe et al., EHC, CV Imaging, 2022; Carpenito et al., 2022 Frontiers in CV medicine; Kupcynska et al., Kariol Pol 2021; Vyff et al., European Heart Journal Open 2023;
LA Strain – Stroke
LASr as risk stratification for ischemic stroke, even without AFIB after CABG — cut-off <23%, 4-times increased risk
LASr <14,5% in HF patients ➜ yearly stroke risk of 2,38% (equalling CHA2DS2-VA 2 points)
LASr <14% as a predictor of stroke in AFIB
LASr <6,4%, LASct >-2,5% = predictor of stroke in amyloidosis without AFIB
LASr <13%; LASct >-3,3% cut-off for increased mortality in amyloidosis
Akintoye, J AM Coll Cardiol Img, 2023; dilateddSachdeva et al., IJC Heart & Vasculature 2021; Kupcynska et al., Kariol Pol 2021; Vyff et al., European Heart Journal Open 2023;
Excursion AFIB
Atrial function RA > LA after CV
Atrial stunning in LA & RA strain – RASct around -5%, LASct -6%
Atrial Stunning & elevation of filling pressures of the LA 3 days after CV, already borderline normal RA Strain
Loop: LASct -2.6%, LASr 11% / Image: RASr 28.7%
Atrial Stunning & elevation of filling pressures of the LA 3 days after CV, already borderline normal RA Strain
Loop: LASct -2.6%, LASr 11% / Image: RASr 28.7%
Rowlands American Heart Jorunal 1967
Dreams of the future, a pie in the sky?
Pressure vs volume LA Strain
Diastolic Strain & twist & untwist (40% untwisting in the first 15% of diastole)
LA stiffness index (E/e’ / LASr)
LA Stiffness Index ➜ E/e’/LASr > 0,26 ➜ elevated mortality & hospitalisations in HFpEF
A higher index in persistent AFIB makes sense
LA Stiffness index normal values by age: ≤0,22 (20-40a); ≤0,42 (40-60a); ≤0,55 (>60a)
More cut-offs
LASr lowest normal border by age: ≥31,1% (20-40a); ≥27,7% (40-60a); ≥22,7% (>60a)
LASr pressure overload (HTN, AS) with a mean of 23,0%, volume overload (HF, MI) 18,9% vs. healthy 33,5%
AFIB: LA-stiffness index: 0,67 elevated
AFIB: LA-stiffness index: 0,67 elevated
AFIB: LA-stiffness index: 0,67 elevated
SR HFpEF: LA-stiffness index significantly elevated: 1,67 with elevated filling pressures & bad prognosis
SR HFpEF: LA-stiffness index significantly elevated: 1,67 with elevated filling pressures & bad prognosis
