Abstract
No data are actually available regarding the left atrial (LA) functional assessment by two-dimensional speckle tracking echocardiography (2D-STE) in early-stage idiopathic pulmonary fibrosis (IPF). The primary end-point of our study was to assess whether global LA peak strain (GLAPS), measured by 2D-STE analysis, may detect early alterations in LA function in IPF patients without right heart failure (RHF). Between September 2017 and January 2019, 50 consecutive IPF patients (73.8 ± 6.8 years, 36 males) without chronic RHF and 30 controls matched by age, sex and cardiovascular risk factors, were enrolled in an observational retrospective case–control study. All patients underwent a complete echocardiographic study implemented with 2D-STE analysis. GLAPS, left ventricular (LV) global longitudinal strain (GLS), right atrial (RA) reservoir strain (GSA+) and right ventricular (RV)-GLS were obtained in each patient. LVFP were significantly increased in IPF patients in comparison to controls (average E/e′ ratio 14.4 ± 3.0 vs 9.6 ± 1.5, p < 0.0001), while LV-GLS was slightly reduced in IPF patients compared to controls (19.4 ± 3.6% vs 21.0 ± 2.2%, p = 0.03).Moreover, GLAPS was significantly impaired in IPF patients in comparison to controls (18.4 ± 3.7% vs 28.4 ± 5.6%, p < 0.0001).Finally, the two groups of patients did not show any statistically significant difference in both RA-GSA + (23.9 ± 3.7% vs 24.5 ± 4.0%, p = 0.49) and RV-GLS (− 22.6 ± 3.3% vs − 23.5 ± 3.0%, p = 0.22). Notably, LV-GLS was strongly inversely correlated both with RV/LV basal diameter ratio and TRV in IPF patients (r = − 0.87 and − 0.82, respectively) but not in controls (r = − 0.29 and − 0.27, respectively). This finding highlights a likely process of ventricular interdependence in non-advanced IPF, with consequent LV diastolic dysfunction and secondary impairment in LV-GLS and GLAPS. Early LA reservoir dysfunction in IPF patients may be secondary to LV diastolic dysfunction induced by ventricular interdependence and may develop before RV diastolic and systolic dysfunction.
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Abbreviations
- 2D:
-
Two-dimensional
- 2D-STE:
-
Two-dimensional speckle tracking echocardiography
- 6MWT:
-
Six-minute walking test
- AF:
-
Atrial fibrillation
- BSA:
-
Body surface area
- CAD:
-
Coronary artery disease
- CI:
-
Confidence interval
- CVD:
-
Cardiovascular disease
- DLCO:
-
Diffusing capacity of the lungs for carbon monoxide
- ECG:
-
Electrocardiogram
- GLAPS:
-
Global left atrial peak strain
- GLS:
-
Global longitudinal strain
- GSA+:
-
Positive global atrial strain
- GSA−:
-
Negative global atrial strain
- GSR+:
-
Positive global strain rate
- GSRE:
-
Global early-diastolic strain rate
- GSRL:
-
Global late-diastolic strain rate
- HF:
-
Heart failure
- HR:
-
Heart rate
- HRCT:
-
High-resolution computed tomography
- ICC:
-
Intraclass correlation coefficient
- ILD:
-
Interstitial lung disease
- IPF:
-
Idiopathic pulmonary fibrosis
- LA:
-
Left atrial
- LV:
-
Left ventricular
- LVFP:
-
Left ventricular filling pressure
- MDRD:
-
Modification of diet in renal disease
- PH:
-
Pulmonary hypertension
- PW:
-
Pulsed-wave
- RHF:
-
Right heart failure
- ROI:
-
Region of interest
- RV:
-
Right ventricular
- SPSS:
-
Statistical package for social science
- SR:
-
Strain rate
- STE:
-
Speckle tracking echocardiography
- TDI:
-
Tissue Doppler imaging
- TGSA:
-
Total global atrial strain
- TLC:
-
Total lung capacity
- TTE:
-
Transthoracic echocardiography
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Acknowledgement
This work has been supported by Italian Ministry of Health Ricerca Corrente—IRCCS MultiMedica.
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Antonella Caminati reports personal fees from Roche and Boehringer Ingelheim, outside the submitted work. Sergio Harari reports grants and personal fees from Roche, Actelion and Boehringer Ingelheim, outside the submitted work. All other authors declares no conflict of interest.
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All procedures performed in the present study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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10554_2020_1887_MOESM1_ESM.jpg
Supplementary file1 Supplemental Table Intra- and interobserver variability analysis of the main conventional and functional echocardiographic parameters, measured in a subgroup of 20 patients. ICC, intraclass correlation coefficient. GLAPS, global left atrial peak strain. LAVi, left atrial volume indexed. LV, left ventricular. LVEDVi, left ventricular end-diastolic volume indexed. LVEF, left ventricular ejection fraction. LVMi, left ventricular mass indexed. RV, right ventricular. TRV, tricuspid regurgitation peak velocity (JPG 1466 kb)
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Sonaglioni, A., Caminati, A., Lipsi, R. et al. Early left atrial dysfunction in idiopathic pulmonary fibrosis patients without chronic right heart failure. Int J Cardiovasc Imaging 36, 1711–1723 (2020). https://doi.org/10.1007/s10554-020-01887-5
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DOI: https://doi.org/10.1007/s10554-020-01887-5