박훈준, , 정해억, 임민경, 최민석, 길욱현, 박찬석, 김범준, 백상홍, 승기배, 홍순조, 최규보 |
Background Despite late diastolic mitral annular velocity (A’) by tissue Doppler echo reliably predicts left atrial systolic function, there is limited data about the clinical implication of A’ related to LA volume. Objective We tested whether A’ is correlated with left atrial volume index (LAVi) and LAVi over A’ (LAVi/A’), as a new echo index, predict elevated left ventricular end-diastolic pressure (LVEDP) and right ventricular systolic pressure (RVSP) Methods Doppler recording of the mitral inflow and tissue Doppler imaging of the mitral annuls were obtained in 100 patients referred to echo lab for evaluation of chest discomfort. In all patients, LAVi was measured using modified Simpson’s method on apical 4-chamber view at end-systole. Right ventricular systolic pressure (RVSP) was estimated using TR velocity. The correlation between A’ and LAVi was analyzed. The value of LAVi/A’ was calculated in each patients and compared with E/E’ and RVSP. Using ROC analysis, sensitivity and specificity of LAVi/A’ for prediction of elevated LVEDP (E/E’>15) or elevated RVSP (> 45 mmHg) were measured Results A’was negatively correlated with LAVi (r=-0.413, p<0.001). The value of LAVi/A’ was well correlated with E/E’ (r=0.640, p<0.001) and significantly different between 3 groups (E/E’<8, 2.33±0.92 ; 8≤E/E’≤15, 3.85±2.43 ; E/E’>15, 6.42±3.20, p<0.001). The area under the receiver-operating curve (AUC) for LAVi/A’ to detect E/E’>15 was 0.85 (95% CI, 0.76 to 0.94; p<0.001). A LAVi/A’ value of 4.24 had a sensitivity of 83%, a specificity of 81%. In addition, A LAVi/A’ was well correlated with the estimated RVSP (r=0.619, p<0.001). The AUC for LAVi/A’ to detect elevated RVSP (>45mmHg) was 0.871 (95% CI, 0.757 to 0.986 ; p <0.001). A LAVi/A’ value of 5.49 had a sensitivity of 88%, a specificity of 86%. Conclusions
Our data suggests that systolic function of left atrium is decreased as left atrial volume is enlarged. As a new echo parameter, LAVi/A’ is useful to predict elevated end-diastolic pressure or high RV systolic pressure, and if the value of LAVi/A’ is more than 5.49, pulmonary hypertension due to significant LV dysfunction must be suspected.
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