The additive value of left atrial function measured by 4D auto left
atrial quantification echocardiography for distinguishing between
pre-capillary and post-capillary pulmonary hypertension
Objective The purpose of this study was to investigate the
value of left atrial (LA) volume and strain by 4D auto left atrial
quantification (LAQ) for differentiating pre- and post-capillary
pulmonary hypertension (PH), and compare the discriminative ability with
echocardiographic pulmonary to left atrial global strain ratio (ePLAGS).
Methods A total of ninety-eight subjects screened for
intermediate to high probability of PH were prospectively enrolled in
this study. Clinical history and laboratory data of all the patients
were collected. All the patients underwent comprehensive transthoracic
echocardiography and then LA volume and strain were measured by
dedicated commercial software specially designed for LA 4D analysis.
Results According to pulmonary arterial wedge pressure, the
participants were divided into two groups: pre-capillary PH Group (n=39,
age 53±24 year) and post-capillary PH Group (n=59, age 57 ± 18 year).
LAVImax, LAVImin and LAVIpreA significantly increased, while LASr and
LAScd obviously decreased in post-capillary PH group when comparing with
pre-capillary PH group. Multivariate logistic regression analysis showed
LAVImax (OR: 1.40; 95% CI, 1.05–1.87; P = 0.021) and LAScd (OR:
1.76; 95% CI, 1.18–2.49; P = 0.004) were powerful independent
predictors for detecting post-capillary PH. The ROC analysis indicated
that LAVImax (AUC=0.82, p < 0.001) and LAScd (AUC=0.78,
p <0.001) had high discriminating power for predicting
post-capillary PH groups, and their cutoff values were 35.69ml/m2
(sensitivity 86%, specificity 74%) and -9% (sensitivity 80%,
specificity70%). Conclusions LAVImax and LAScd measured by 4D
auto LAQ were powerful parameters for distinguishing pre-capillary PH
from post-capillary PH.