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Left atrial deformation and nonischemic dilated cardiomyopathy

A 2D speckle-tracking imaging study

Linksatriale Deformation und nichtischämische dilatative Kardiomyopathie

2-D-Speckle-Tracking-Bildgebungs-Studie

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Abstract

Background

Left ventricular filling pressure (LVFP) is raised by the compromised contraction and impaired ventricular compliance in dilated hearts with systolic dysfunction. Timely recognition and staging of this condition are important for planning of the treatment strategy and making the prognosis. Two-dimensional speckle- tracking echocardiography (2D-STE) has recently enabled the quantification of left atrial (LA) myocardial deformation dynamics. In this study, echocardiographic indicators of increased LVFP and NT-pro-BNP were compared with LA strain measured by 2D-STE.

Methods

A total of 49 nonischemic dilated cardiomyopathy (DCMP) patients were included in the study. All patients underwent standard 2D echocardiography. In the 2D-STE analysis of the LA, global longitudinal LA strain during ventricular systole (GLAs-res) and strain during late diastole (GLAs-pump) were obtained. NT-pro-BNP levels were measured. The patients were divided into two groups—normal (group 1) and increased (group 2) LVFP—according to E/A ratio, E velocity, and E/E’ ratio.

Results

LAVi-max, LAVi-min, and NT-pro-BNP were higher in group 2, whereas LAtotalEF, LAactiveEF, GLAs-res, and GLAs-pump were lower. In univariate analysis, a good negative correlation was seen between GLAs-res vs. NT-pro-BNP, GLAs-res vs. LAVi-max, and GLAs-res vs. E/E’ ratio; a good negative correlation was present between GLAs-pump vs. NT-pro-BNP, GLAs-pump vs. LAVi-max, and GLAs-pump vs. E/E’ ratio. LAVi-max, LAactiveEF, NT-pro-BNP, GLas-res, and GLAs-pump were studied by logistic regression analysis. GLAs-res (p = 0.009, OR = 0.593, 95 % CI 0.4–0.877), NT-pro-BNP (p = 0.028, OR = 1.027, 95 % CI 1.003–1.052), and LAactiveEF (p = 0.022, OR = 0.001, 95 % CI 0.001–0.024) were found to be independent predictors of increased LVFP.

Conclusion

2D-STE-based LA function is impaired in patients with nonischemic DCMP. LA reservoir and pump function parameters together with NT-pro-BNP levels might be useful in estimating LVFP in this patient group.

Zusammenfassung

Hintergrund

Der linksventrikuläre Füllungsdruck (LVFP) ist durch die beeinträchtigte Kontraktion und gestörte ventrikuläre Compliance bei einer Herzdilatation mit systolischer Funktionsstörung erhöht. Zur Planung der Therapiestrategie und Vorhersage der Prognose sind die frühzeitige Erkennung und Klassifizierung dieser Erkrankung von Bedeutung. Durch die 2-D-Speckle-Tracking-Echokardiographie (2D-STE) ist die Quantifizierung der linksatrialen myokardialen Deformationsdynamik seit Kurzem möglich geworden. In der vorliegenden Studie wurden echokardiographische Indikatoren eines erhöhten LVFP und NT-pro-BNP („n-terminal pro brain natriuretic peptide“) mit der per 2D-STE gemessenen linksatrialen Deformierung („strain“) verglichen.

Methoden

Insgesamt wurden 49 Patienten mit nichtischämischer dilatativer Kardiomyopathie (DCMP) in die Studie aufgenommen. Bei sämtlichen Patienten erfolgte eine Standard-2-D-Echokardiographie. Mit der 2D-STE wurden die globale longitudinale linksatriale Deformierung während der Ventrikelsystole (GLAs-res) und die Deformierung während der späten Diastole (GLAs-pump) ermittelt. Auch die NT-pro-BNP-Werte wurden bestimmt. Die Patienten wurden in 2 Gruppen aufgeteilt, je nachdem, ob der LVFP gemäß E/A-Verhältnis, E-Geschwindigkeit und E/E‘-Verhältnis normal (Gruppe 1) oder erhöht (Gruppe 2) war.

Ergebnisse

In Gruppe 2 waren LAVi-max, LAVi-min und NT-pro-BNP höher, LAtotalEF, LAactiveEF, GLAs-res und GLAs-pump dagegen niedriger. In der univariaten Analyse wurde eine gute negative Korrelation zwischen GLAs-res vs. NT-pro-BNP, GLAs-res vs. LAVi-max und GLAs-res vs. E/E’-Verhältnis beobachtet, und eine gute negative Korrelation fand sich zwischen GLAs-pump vs. NT-pro-BNP, GLAs-pump vs. LAVi-max und GLAs-pump vs. E/E’-Verhältnis. LAVi-max, LAactiveEF, NT-pro-BNP, GLas-res und GLAs-pump wurden mittels logistischer Regressionsanalyse untersucht. GLAs-res (p = 0,009; OR = 0,593; 95 %-KI: 0,4–0,877), NT-pro-BNP (p = 0,028; OR = 1,027; 95 %-KI: 1,003–1,052) und LAactiveEF (p = 0,022; OR = 0,001; 95 %-KI: 0,001–0,024) stellten sich als unabhängige Prädiktoren eines erhöhten LVFP heraus.

Schlussfolgerung

Die mit der 2D-STE ermittelte linksatriale Funktion ist bei Patienten mit nichtischämischer DCMP beeinträchtigt. Die Parameter für die Reservoir- und Pumpfunktion des linken Vorhofs könnten zusammen mit den NT-pro-BNP-Werten bei der Abschätzung des LVFP in dieser Patientengruppe von Nutzen sein.

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On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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  1. Cardiology Clinic, Kosuyolu Heart, Education & Research Hospital, 34846, Kartal, Istanbul, Turkey

    A. Guler, K.M. Tigen, C. Dundar, T. Karaahmet, C.Y. Karabay, S.M. Aung, T. Akgun, M. Bulut & C. Kirma

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  1. A. Guler
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Guler, A., Tigen, K., Dundar, C. et al. Left atrial deformation and nonischemic dilated cardiomyopathy. Herz 39, 251–257 (2014). https://doi.org/10.1007/s00059-013-3817-z

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