{"title":"The diagnostic value of left atrial stiffness for heart failure with preserved ejection fraction in patients with paroxysmal atrial fibrillation.","authors":"Jinzhi Lai, Xiaohan Qin, Dingding Zhang, Jiaqi Wang, Jiaqi Yu, Keyue Sun, Deyan Yang, Jingbo Fan, Lihua Zhang, Zhongwei Cheng, Kangan Cheng, Peng Gao, Hua Deng, Ligang Fang, Taibo Chen, Quan Fang, Yongtai Liu","doi":"10.1186/s44156-026-00107-5","DOIUrl":null,"url":null,"abstract":"<p><p>AIMS: Left atrial (LA) function is impaired in both atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Diagnosing HFpEF remains challenging, especially in AF patients. This study aims to evaluate whether LA stiffness (LAS) can facilitate the diagnosis of HFpEF in patients with paroxysmal atrial fibrillation (pxAF). METHODS AND RESULTS: A total of 187 pxAF patients were enrolled in the discovery cohort and underwent baseline transthoracic echocardiography (TTE). LAS was measured in all patients, and HFpEF was ascertained based on the H2FPEF score (44 high-probability of HFpEF [hp-HFpEF], 143 low-probability of HFpEF [lp-HFpEF]). The left ventricular diastolic function and LA function were significantly altered in the hp-HFpEF group compared to the lp-HFpEF group. Among all echocardiographic indices, the ratio of E/MVE’ to 3D LAEF as a surrogate of LAS showed the greatest diagnostic performance in distinguishing hp-HFpEF from lp-HFpEF in pxAF patients (AUC = 0.862, 95% CI 0.801–0.922, p < 0.001), with an optimal cutoff value of 0.27. Combining MVE’ and LAS revealed the highest diagnostic efficiency (LR + 12.18) compared to any single variable. The discriminatory value of LAS with MVE’ was further verified in the validation cohort with an LR + of 7.18. CONCLUSION: LAS analyzed by conventional echocardiography combined with MVE’ is a non-invasive, decision-support approach for discriminating hp-HFpEF from lp-HFpEF in pxAF patients. The clinical trial registration number: ClinicalTrials.gov NCT05266144. </p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"13 1","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927242/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Echo Research and Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s44156-026-00107-5","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
AIMS: Left atrial (LA) function is impaired in both atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Diagnosing HFpEF remains challenging, especially in AF patients. This study aims to evaluate whether LA stiffness (LAS) can facilitate the diagnosis of HFpEF in patients with paroxysmal atrial fibrillation (pxAF). METHODS AND RESULTS: A total of 187 pxAF patients were enrolled in the discovery cohort and underwent baseline transthoracic echocardiography (TTE). LAS was measured in all patients, and HFpEF was ascertained based on the H2FPEF score (44 high-probability of HFpEF [hp-HFpEF], 143 low-probability of HFpEF [lp-HFpEF]). The left ventricular diastolic function and LA function were significantly altered in the hp-HFpEF group compared to the lp-HFpEF group. Among all echocardiographic indices, the ratio of E/MVE’ to 3D LAEF as a surrogate of LAS showed the greatest diagnostic performance in distinguishing hp-HFpEF from lp-HFpEF in pxAF patients (AUC = 0.862, 95% CI 0.801–0.922, p < 0.001), with an optimal cutoff value of 0.27. Combining MVE’ and LAS revealed the highest diagnostic efficiency (LR + 12.18) compared to any single variable. The discriminatory value of LAS with MVE’ was further verified in the validation cohort with an LR + of 7.18. CONCLUSION: LAS analyzed by conventional echocardiography combined with MVE’ is a non-invasive, decision-support approach for discriminating hp-HFpEF from lp-HFpEF in pxAF patients. The clinical trial registration number: ClinicalTrials.gov NCT05266144.
期刊介绍：
Echo Research and Practice aims to be the premier international journal for physicians, sonographers, nurses and other allied health professionals practising echocardiography and other cardiac imaging modalities. This open-access journal publishes quality clinical and basic research, reviews, videos, education materials and selected high-interest case reports and videos across all echocardiography modalities and disciplines, including paediatrics, anaesthetics, general practice, acute medicine and intensive care. Multi-modality studies primarily featuring the use of cardiac ultrasound in clinical practice, in association with Cardiac Computed Tomography, Cardiovascular Magnetic Resonance or Nuclear Cardiology are of interest. Topics include, but are not limited to: 2D echocardiography 3D echocardiography Comparative imaging techniques – CCT, CMR and Nuclear Cardiology Congenital heart disease, including foetal echocardiography Contrast echocardiography Critical care echocardiography Deformation imaging Doppler echocardiography Interventional echocardiography Intracardiac echocardiography Intraoperative echocardiography Prosthetic valves Stress echocardiography Technical innovations Transoesophageal echocardiography Valve disease.
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