Reliability of two-dimensional speckle tracking echocardiography in assessment of left atrial function in postmenopausal hypertensive women
DOI:
https://doi.org/10.14739/2310-1210.2018.1.121875Keywords:
speckle tracking echocardiography, left atrium, women, hypertension, menopauseAbstract
Left atrium (LA) state reflects the severity of cardiovascular remodeling and indicates the degree of compensation in many cardiovascular diseases, including arterial hypertension (AH). Transthoracic echocardiography determines linear and volumetric parameters of LA, but it has limitations in early stages of AH. Speckle tracking echocardiography is a new technique which can identify early subclinical dysfunction of cardiac chambers.
The purpose of the study was 1) to assess feasibility, intra- and inter-observer reproducibility of LA longitudinal strain (LS) derived by both P- and R-wave triggering method; 2) to compare LA strain values obtained by P- and R-wave synchronization in hypertensive postmenopausal women.
Material and methods. The study involved 65 post-menopausal hypertensive women (mean age – 56.8 ± 8.15 years). All patients underwent a standard transthoracic and two-dimensional speckle tracking echocardiography using Vivid E9 XDClear Console 4D Expert 100 (GeneralElectric,USA). Apical four- and two-chamber views images were obtained during breath hold with ECG synchronization. All statistical analyses were performed using SPSS 20 for Windows (SPSS, Inc.,Chicago,IL).
Results. Initial feasibility of echocardiographic data for performing LA strain analysis was 93.85 %. Adequate tracking quality was achieved in 96.93 % of segments by P-triggering and in 96.35 % by R -wave as initial point of analysis. The intra-class correlation (ICC) coefficient for R-triggering was 0.96 (95 % CI 0.89–0.98) for intra-observer and 0.94 (95 % CI – 0.52–0.97) for inter-observer variability. The ICC coefficients for P-triggering were higher 0.97 (95 % CI 0.92–0.99) and 0.96 (95 % CI – 0.9–0.98), respectively. The Bland-Altman statistic confirmed absence of bias in both variants of ECG-triggering. Values ofLA LS calculated by R-triggering method were significantly higher than those ones by P-triggering (P < 0.001).
Conclusions. Speckle tracking echocardiography is a reliable technique, which provides quantitative assessment of LA physiology. The P-wave triggering method of LA strain analysis is more reproducible compared with R-wave triggering variant. TheLA LS values differ significantly depending on ECG-triggering type (P- or R wave), providing higher values by R-wave triggering method.
References
Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., Böhm, M., et al. (2013). ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Journal of hypertension, 31(7), 1281–1357. doi: 10.1097/01.hjh.0000431740.32696.cc.
Patel, D. A., Lavie, C. J., Gilliland, Y. E., Shah, S. B., Dinshaw, H. K., & Milani, R. V. (2015). Prediction of all-cause mortality by the left atrial volume index in patients with normal left ventricular filling pressure and preserved ejection fraction. Mayo Clin. Proc., 90(11), 1499–1505. doi: 10.1016/j.mayocp.2015.07.021
Morris, D. A., Takeuchi, M., Krisper, M., Kohncke, C., Bekfani, T., Carstensen, T., et al. (2015). Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging, 16(4), 364–372. doi: 10.1093/ehjci/jeu219
Saraiva, R. M., Demirkol, S., Buakhamsri, A., Greenberg, N., Popović, Z. B., Thomas, J. D., & Klein, A. L. (2010). Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J. Am. Soc. Echocardiogr., 23(2), 172–180. doi: 10.1016/j.echo.2009.11.003.
Miglioranza, M. H., Badano, L. P., Mihăilă, S., Peluso, D., Cucchini, U., Soriani, N., et al. (2016). Physiologic determinants of left atrial longitudinal strain: a two-dimensional speckle-tracking and three-dimensional echocardiographic study in healthy volunteers. J Am Soc Echocardiogr, 29(11), 1023–1034. doi: 10.1016/j.echo.2016.07.011.
Costa, C., González-Alujas, T., Valente, F., Aranda, C., Rodríguez-Palomares, J., Gutierrez, L., et al. (2016). Left atrial strain: a new predictor of thrombotic risk and successful electrical cardioversion. Echo Res. Pract., 3(2), 45–52. doi: 10.1530/ERP-16-0009.
Galli, E., Fournet, M., Chabanne, C., Lelong, B., Leguerrier, A., Flecher, E., et al. (2016). Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study. European Heart Journal Cardiovascular Imaging, 17(5), 533–541. doi: 10.1093/ehjci/jev230
Aung, S. M., Güler, A., Güler, Y., Huraibat, A., Karabay, C. Y., & Akdemir, I. (2017). Left atrial strain in heart failure with preserved ejection fraction. Herz, 42(2), 194–199. doi: 10.1007/s00059-016-4456-y.
Hayashi, S., Yamada, H., Bando, M., Saijo, Y., Nishio, S., Hirata, Y., et al. (2015). Optimal analysis of left atrial strain by speckle tracking echocardiography: P-wave versus R-wave trigger. Echocardiography, 32(8), 1241–1249. doi: 10.1111/echo.12834
Lang, R. M., Badano, P. L., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., et al. (2015). Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr, 28(1), 1-39.e14. doi: 10.1016/j.echo.2014.10.003.
Yasuda, R., Murata, M., Roberts, R., Tokuda, H., Minakata, Y., Suzuki, K., et al. (2015). Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation. European Heart Journal Cardiovascular Imaging, 16(9), 1008–1014. doi: 10.1093/ehjci/jev028
Vincent, W. J. (2005). Statistics in Kinesiology. Champaign, IL: Human Kinetics.
Bland, J. M., & Altman, D. G. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1(8476), 307–310. doi: https://doi.org/10.1016/S0140-6736(86)90837-8
Rimbas, R. C., Mihaila, S., & Vinereanu, D. (2016). Sources of variation in assessing left atrial functions by 2D speckle-tracking echocardiography. Heart Vessels, 31(3), 370–381. doi: 10.1007/s00380-014-0602-8
Cameli, M., Caputo, M., Mondillo, S., Ballo, P., Palmerini, E., Lisi, M., et al. (2009). Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound, 7, 6. doi: 10.1186/1476-7120-7-6.
Kim, D. G., Lee, K. J., Lee, S., Jeong, S. Y., Lee, Y. S., Choi, Y. J., et al. (2009). Feasibility of two-dimensional global longitudinal strain and strain rate imaging for the assessment of left atrial function: a study in subjects with a low probability of cardiovascular disease and normal exercise capacity. Echocardiography, 26(10), 1179–1187. doi: 10.1111/j.1540-8175.2009.00955.x
Saraiva, R. M., Demirkol, S., Buakhamsri, A., Greenberg, N., Popovic, Z. B., & Thomas, J. D. (2010). Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr, 23(2), 172–180. doi: 10.1016/j.echo.2009.11.003.
Morris, D. A., Takeuchi, M., Krisper, M., Kohncke, C., Bekfani, T., Carstensen, T., et al. (2015). Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging, 16(4), 364–372. doi: 10.1093/ehjci/jeu219
Boyd, A. C., Richards, D. A., Marwick, T., & Thomas, L. (2011). Atrial strain rate is a sensitive measure of alterations in atrial phasic function in healthy ageing. Heart, 97(18), 1513–1519. doi: 10.1136/heartjnl-2011-300134
Kurt, R. K., Nacar, A. B., Güler, A., Silfeler, D. B., Buyukkaya, E., Karateke, A., et al. (2014). Menopausal cardiomyopathy: Does it really exist? A case–control deformation imaging study. J. Obstet. Gynaecol. Res., 40(6), 1748–1753. doi: 10.1111/jog.12368
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