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- Tossavainen, Erik, et al.
(författare)
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Left Atrial Intrinsic Strain Rate Correcting for Pulmonary Wedge Pressure Is Accurate in Estimating Pulmonary Vascular Resistance in Breathless Patients
- 2016
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Ingår i: Echocardiography. - : Wiley-Blackwell. - 0742-2822 .- 1540-8175. ; 33:8, s. 1156-1165
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We hypothesized that left atrial deformation during atrial systole (LASRa) correlates with pulmonary capillary wedge pressure (PCWP), thus enabling echo-derived pulmonary vascular resistance (PVR) estimation in a wide range of different subsets of patients.BACKGROUND: Various etiologies of pulmonary hypertension (PH) have different mechanisms and treatments for breathlessness. Irrespective of the location of the underlying pulmonary vascular pathology, pre- or postcapillary, the resulting PH is fairly easy to assess by Doppler echocardiography, but PVR remains a challenge.METHODS: We prospectively included 46 patients (mean age 61 ± 13 years) in sinus rhythm, who underwent right heart catheterization because of dyspnea. According to the NICE guidelines classification, 22 belonged to group 1 pulmonary artery hypertension (PAH), 19 belonged to group 2 congestive heart failure (CHF), 1 belonged to group 4 chronic thromboembolic pulmonary hypertension (CTEPH), and 4 had normal hemodynamics. Simultaneous Doppler echocardiography using spectral, tissue Doppler, and speckle tracking echocardiography techniques for assessing LA structure and function was performed.RESULTS: PCWPrhc correlated with LASRa (r(2) = 0.65, P < 0.001). PCWPecho was calculated using the equation (PCWPecho = 26.12 - 11.09 × LASRa), and the resulting PVR echo strongly correlated with the respective catheter-based measurements PVRrhc (r(2) = 0.69. P < 0.001) with a sensitivity of 85% and specificity of 74% identifying a PVR ≥ 3 WU.CONCLUSIONS: Left atrial strain rate during atrial systole correlates closely with pulmonary capillary wedge pressure and consequently the calculated pulmonary vascular resistance, irrespective of the etiology of PH.
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