Relation of left ventricular end-diastolic pressure and N-terminal pro-brain natriuretic peptide level with left atrial deformation parameters

Mustafa Kurt, Ibrahim Halil Tanboga, Enbiya Aksakal, Ahmet Kaya, Turgay Isik, Mehmet Ekinci, Emine Bilen
European Heart Journal Cardiovascular Imaging 2012, 13 (6): 524-30

AIMS: It has been shown that speckle-tracking echocardiography (STE) is a feasible and reproducible method to assess left atrial (LA) function. The relationship between left ventricular end-diastolic pressure (LVEDP) and brain natriuretic peptide (BNP) with LA deformation parameters has not been studied comprehensively. Therefore, we propose to investigate the effects of invasively obtained LVEDP and BNP level on LA deformation parameters assessed by STE and to show the relationship between them.

METHODS AND RESULTS: The study population consisted of 62 patients who underwent cardiac catheterization. LVEDP was obtained with a fluid-filled catheter. All patients underwent standard two-dimensional echocardiography. In STE analysis for LA, the peak LA strain at the end of the ventricular systole (LAs-strain) and the LA strain with LA contraction (LAa-strain) were obtained. N-terminal pro-BNP (NT-pro-BNP) levels were measured. The univariate correlation analysis demonstrated that the LAs-strain and LAa-strain had good inverse correlation with LVEDP, and the LAs-strain and LAa-strain only had a moderate correlation with NT-pro-BNP. The area under the receiver-operating characteristic curve of the LAs-strain was 0.96 (0.86-0.99, P < 0.001), and for the LAa-strain, the area was 0.88 (0.74-0.96, P < 0.001) to predict increased LVEDP. A multiple regression analysis demonstrated that the LAs-strain, LAV(max), and LV ejection fraction were independent predictors of increased LVEDP among the covariates examined; however, the LAa-strain and LV mass index were not independent predictors. A borderline statistical significance was found for NT-pro-BNP.

CONCLUSION: LAs-strain more closely related with LVEDP and NT-pro-BNP level than LAa-strain. LAs-strain thus might be used clinically to predict increased LVEDP.

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