Left Atrial Strain for assessment of left ventricle diastolic dysfunction in acute coronary syndrome patients.

INTRODUCTION: Patients with acute coronary syndrome (ACS) have a high incidence of Left ventricle diastolic dysfunction (DD). Latest algorithms for the assessment of DD lay on 2D parameters and describe a grading to quantify its severity. However, there persists a "gray zone" of values in which DD remains indeterminate. AIM: to analyze the diagnostic value of Left atrium strain (LAS) for categorization of LV DD and assessment of LV filling pressures in ACS patients. METHODS: Cross-sectional study that prospectively evaluated 105 patients presenting ACS with preserved LV ejection fraction (LVEF). Patients were divided in 4 groups according to the DD grade. Mean values of LAS, corresponding to three phases of atrial function: reservoir (LASr), conduit (LAScd) and contraction (LASct), were obtained by speckle-tracking echocardiography. RESULTS: Mean age was 60±10 years, with a gender ratio of 6.14. LASr and LASct were significantly lower according to DD severity (p combined=0.021, p combined=0.034; respectively). E/e' ratio was negatively correlated to LASr (r= - 0.251; p= 0.022) and LASct (r= -0.197; p=0.077). Left atrial volume index (LAVI) was also negatively correlated to LASr (r= -0.294, p= 0.006) and LASct (r= -0.3049, p=0.005). Peak tricuspid regurgitation was negatively correlated to LASr (r=-0.323, p=0.017) and LASct (r=-0.319, p=0.020). Patients presenting elevated LV filling pressures had lower LASr and LASct (p=0.049, p=0.022, respectively) compared to patients witn normal LV filling pressures. ROC curve analysis showed that a LASr < 22% (Se= 75%, Sp= 73%) and a LASct < 13% (Se= 71%, Sp=58%) can increase the likelihood of DD grade II or III by 4.6 (OR= 4.6; 95% CI: 1.31-16.2; p=0.016) and 3.7 (OR= 3.7; 95% CI: 1.06-13.1; p= 0.047), respectively. CONCLUSION: LAS is a valuable tool, which can be used to categorize DD in ACS patients.

Prognostic value of ambulatory blood pressure monitoring in treated hypertensive patients.

INTRODUCTION: Ambulatory blood pressure monitoring (AMBP) has become a valuable tool for analyzing patient blood pressure (BP) pro-file to make a more accurate prognosis compared to clinical office BP. AIM: To identify the prognostic value of different parameters of ABPM and the future course of cardiovascular events (CVE) in treated hypertensive patients. METHODS: We conducted a prospective, descriptive study, including treated hypertensive patients which had consulted between 2015 and 2016 and had a systematic ABPM during their follow-up. Patients were followed at the outpatient clinics for 4 years, and we searched in the computerized medical file the occurrence of CVE. RESULTS: A total of 240 patients were included in our study with masculine predominance (57%). The mean age was 57.4±9.5 years. During 4 years of follow-up, 30 patients (12.5%) experienced a CVE. The total number of CVE was 32: acute heart failure (3), acute co-ronary syndrome (15), atrial fibrillation (12), stroke (2). Daytime systolic blood pressure (SBP), night-time SBP, 24-h SBP and 24-h pulse pressure (PP), had similar performances to predict CVE. Only the 24-h PP (OR= 1.072; 95% IC: 1.019-1.128; p= 0.007) was found to be an independent predictor of CVE. A 24-h PP> 55 mmHg increased the risk of CVE by 3.2. CONCLUSION: SBP and PP were associated with CVE in treated hypertensive patients. the 24-h PP was found to be an independent pre-dictor of CVE so it may serve as a therapeutic target in hypertension therapy.

Correlation between left atrial strain and left ventricular filling pressure in patients suspected of heart failure with a preserved left ventricular ejection fraction.

INTRODUCTION: Despite different ultrasound parameters, left ventricular filling pressures (LVFP) assessment remains inconclusive in some cases. AIM: To determine the contribution of left atrial strain (LAS) in estimating LVFP in patients with exertional symptoms and preserved left ventricular ejection fraction. METHODS: This was a monocentric study, carried out in the cardiology department of the Interior Security Forces Hospital, La Marsa, between October 2021 and March 2022. Patients with exertional symptoms had a physical examination, a biological assessment and an ultrasound examination at rest and, if necessary, during exercise. We investigated the performance of LAS components (Peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit function (FnC) in predicting LVFP rising. Patients were categorized into two final groups according to LVFP: Group A= high LVFP at rest or during exercise (25 patients) and Group B= not-high LVFP at rest and during exercise (48 patients). RESULTS: Seventy-three patients were enrolled in the study, with a mean age of 61±12 years and a majority being female (57%). The median PALS was 29.3% [21.4-32.4]. The mean PACS and FnC values were 13.4%±4.9 and 13.7%±4.7, respectively. Patients with high LVFP demonstrated lower LAS parameters and elevated NT-Pro BNP levels. LAS showed negative correlations with the E/e' ratio and NT-Pro BNP. PALS emerged as an independent predictor of LVFP elevation (HR=0.71; 95% CI: 0.513-0.986; p=0.041). CONCLUSION: This study highlights that LAS, as a simple ultrasound parameter, can effectively predict high LVFP.