Novel Data on Left Atrial Strain by Echocardiography in Patients with Heart Failure and Preserved Ejection Fraction.

Abstract

Background: This study confronts the diagnostic challenge of identifying diastolic heart failure (HF) in patients with normal systolic function in the early stages of HF.

Materials and methods: The study evaluated patients with HF symptoms, excluding those with evidence of increased ventricular filling pressure. All patients underwent stress echocardiography and were categorized into two groups: Heart failure with preserved ejection fraction (HFpEF) (elevated left ventricular end-diastolic pressure) and those with normal left ventricle filling pressure. Echocardiography measured left atrial (LA) strain in three phases.

Results: Among the 64 patients, 47 exhibited Grade 1 diastolic dysfunction (DD), and 17 had Grade 2 dysfunction (HFpEF). Echocardiographic factors, including the peak jet velocity of tricuspid regurgitation (TR) exercise, A during rest, E/E' during rest and exercise, LA volume, LA volume index, LA vol index/S1 + S2 + S3, LA vol index/Strain 1, and LA stiffness (E/E'/Strain 1) were significantly lower in Grade 1 diastolic HF than in Grade 2 patients. In contrast, E during rest and exercise, E' during exercise, Strain 1, Strain 2, Strain 3, S1 + S2 + S3, and LVEDD/body surface area were significantly higher in Grade 1 diastolic HF than in Grade 2 patients. In receiver-operating characteristic curve analysis, LA vol index/S1 + S2 + S3, LA vol index/S1, Strain 1, S1 + S2 + S3, and E/E'/Strain 1 showed the potential clinical applicability in diagnosing diastolic HF.

Conclusion: Alterations in atrial strain could potentially serve as an early indicator for diagnosing DD. Atrial stiffness with a cutoff of 1.25 can distinguish Grade 2 HF from Grade 1 with high sensitivity and specificity. However, more investigations in this field are warranted.